儿童念珠菌血症的菌株分布及耐药性分析  

Species distribution and drug resistance analysis of candidemia in children

作　　者：赵梦川 张文超[1] 邢建 王会茹[1] 李梅[1] 段素霞 翟宇 徐茜茹 王冬雪 李圆龙 郭映辉[1] ZHAO Mengchuan;ZHANG Wenchao;XING Jian;WANG Huiru;LI Mei;DUAN Suxia;ZHAI Yu;XU Qianru;WANG Dongxue;LI Yuanlong;GUO Yinghui(Department of Laborotory Medicine,Children’s Hospital of Hebei Province,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院检验科,石家庄050031

出　　处：《中国真菌学杂志》2025年第1期34-38,共5页Chinese Journal of Mycology

基　　金：河北省政府资助临床医学优秀人才培养项目(ZF2023207)。

摘　　要：目的 分析儿童念珠菌血症的菌株分布情况和耐药性,为儿童念珠菌血症的预防和合理诊疗提供依据。方法 回顾性分析2013年1月—2022年12月于河北省儿童医院住院的念珠菌血症患儿的临床资料,对人口学特征、菌种分布、科室来源和抗真菌药物敏感性等进行分析。结果 共选取非重复性念珠菌血症患儿103例,男性70例,占67.96%,29 d~3岁婴幼儿55例,占53.40%。菌种分布以白念珠菌(67/103,65.05%)为主,其次为近平滑念珠菌(16/103,15.53%)和热带念珠菌(11/103,10.68%)。10年间念珠菌血症患儿中非白念珠菌的分离比例总体呈升高趋势,而白念珠菌的分离比例总体呈降低趋势。念珠菌血症患儿主要来源于外科,构成比为45.63%(47/103),其次为新生儿科(23/103,22.33%)和血液科(13/103,12.62%)。白念珠菌、近平滑念珠菌、热带念珠菌和光滑念珠菌4种念珠菌对5-氟胞嘧啶和两性霉素B的敏感率均为100%;近平滑念珠菌和光滑念珠菌对唑类药物的敏感率为100%;白念珠菌对唑类药物的敏感性较好,对氟康唑、伊曲康唑和伏立康唑的敏感率均大于92%;但热带念珠菌对唑类药物的耐药率高,对氟康唑、伊曲康唑和伏立康唑的耐药率分别为54.55%、36.36%和45.45%。结论 儿童念珠菌血症好发于3岁以下婴幼儿,以白念珠菌为主,非白念珠菌随时间变化呈升高趋势,5-氟胞嘧啶和两性霉素B可用于我院念珠菌血症的经验治疗,对于热带念珠菌引起的血流感染应谨慎使用唑类药物。Objective To investigate the species distribution and resistance profile of children’s candidemia,and to provide evidence for prevention and reasonable diagnosis and treatment of candidiemia.Methods A retrospective analysis was carried out to analysis the clinical data of children with candidiemia hospitalized in Hebei Children’s Hospital from January 2013 to December 2022.The demographic characteristics,species distribution,department source and antifungal drug sensitivity were analyzed.Results A total of 103 children with non-repetitive candidiemia were enrolled,including 70 males(67.96%)and 55 infants aged 29 days to 3 years(53.40%).Candida albicans(67 cases,65.05%)had the highest detection rate,followed by C.parapsilosis(16 cases,15.53%)and C.tropicalis(11 cases,10.68%).Over the last 10 years,the proportion of non-albicans Candida isolated in children with candidiemia showed an increasing trend,while the proportion of C.albicans showed a decreasing trend.The patients with candidemia were mainly from the surgery departmentsurgery department(47/103,45.63%),followed by the neonatology department(23/103,22.33%)and hematology department(13/103,12.62%).The susceptibility(wild type)rates of C.albicans,C.parapsilosis,C.tropicalis and C.glabrata to 5-fluorocytosine and amphotericin B were 100%.The sensitivity rates of C.parapsilosis and C.glabrata to azole antifungal drugs were 100%.The sensitivity of C.albicans to azole was higher than 92%.However,the resistance rates of C.tropicalis to fluconazole,itraconazole and voriconazole were 54.55%,36.36%and 45.45%,respectively.Conclusions Children with candidiemia usually occured in infants under 3 years of age,mainly caused by Candida albicans,and non-albicans Candida showing an increasing trend with time.5-fluorocytosine and amphotericin B could be used in the empirical treatment of candidiemia in our hospital.Azole antifungal drugs should be used with care for bloodstream infections caused by C. tropicalis.

关 键 词：念珠菌血症 儿童 菌株分布 药物敏感性 

分 类 号：R519.3[医药卫生—内科学]