外阴阴道念珠菌病患者耐氟康唑白念珠菌克隆流行分析

摘要

Objective To investigate the distribution and molecular epidemiology of Candida strains isolated from vulvovaginal candidiasis in Shanghai,and conduct molecular phylogenetic analysis of the strains.Methods Candida pathogens were collected from the patients with vulvovaginal candidiasis during the period from August 2015 to February 2016 in Obstetrics and Gynecology Hospital of Fudan University,Shanghai First Maternity and Infant Hospital,and Intemational Peace Matemity and Child Health Hospital.All the strains were identified and statistically analyzed.ATB FUNGUS 3 kit was used to determine the minimum inhibitory concentration of antifungal agents against these strains in vitro.Molecular typing was conducted using multilocus sequence typing (MLST) method.Phylogenetic analysis was carried out by eBURST and MEGA 6 software.Results Of the 2 185 strains of Candida,1 988 were identified as Candida albicans,149 Candida glabrata,20 Candida tropicalis and 28 other Candida species.Overall,6.5％ of the Candida albicans strains were resistant to fluconazole.Twenty-six diploid sequence types (DSTs) were identified among the 93 strains of Candida albicans analyzed,including 50 fluconazole-susceptible strains with sporadic genotypes,but 43 fluconazole-resistant strains clustered as one clonal complex (CC 69) on the same branch (MLST Clade 1) of phylogenetic tree.Conclusions Candida albicans was the main pathogen of vulvovaginal candidiasis in the three obstetrics & gynecology hospitals in Shanghai,which showed slightly higher resistance to fluconazole.It is necessary to monitor the spread of fluconazole-resistant Candida albicans in these hospitals,especially clonal dissemination of CC 69 clone.%目的 探讨上海地区外阴阴道念珠菌病的菌种分布及其主要致病菌的分子流行特点,并进行菌株遗传进化分析.方法 收集2015年8月至2016年2月复旦大学附属妇产科医院、上海市第一妇婴保健院及国际和平妇幼保健院3所医院外阴阴道念珠菌病患者分离得念珠菌共2 1 85株,进行菌种鉴定及统计分析,并采用ATB FUNGUS 3试剂盒检测抗真菌药物体外最低抑菌浓度,对其主要致病菌运用多位点序列分型(MLST)的方法进行分子分型,同时应用eBURST和MEGA6.0软件进行遗传进化分析.结果 2 185株念珠菌属中共鉴定出白念珠菌1 988株,光滑念珠菌149株,热带念珠菌20株,其他念珠菌28株;白念珠菌对氟康唑耐药率为6.5％;93株白念珠菌共检测出26个二倍体序列型(DST),其中50株敏感菌序列型为分散分布,而43株耐氟康唑白念珠菌集中于同一个克隆复合体(CC 69),并处于同一个进化树分枝上(Clade 1).结论 白念珠菌是上海地区3所妇产科医院外阴阴道念珠菌病的主要致病菌,对三唑类药物的耐药率较高,而且耐氟康唑白念珠菌表现为CC 69的克隆传播流行,需要进行重点监控.