江西南昌市52株假丝酵母菌血症病原真菌的鉴定及其药敏特征

摘要

Objective To explore the constitute and antimicrobial susceptibility of pathogenic fungi causing candidemia in Nanchang City of Jiangxi Province.Methods Candida spp.isolated from blood specimens of patients at a hospital in Nanchang in March-October 2015 were collected, fungal strains were identified by amplifying the internal transcribed spacer (ITS) and large ribosomal subunit (D1/D2 region of 26rRNA), antifungal susceptibility of fungi was detected.Results A total of 1 332 positive blood culture specimens were collected, including 74 fungal positive specimens, accounting for 5.56％, 52 strains of Candida spp.were obtained, most were Candida tropicalis (n=17,32.69％),followed by Candida albicans(n=16, 30.77％) and Candida parapsilosis complex (n=16, 30.77％).Identification results of ITS and D1/D2 region were identical.52 strains of Candida spp.were sensitive to both micafungin and caspofungin, epidemiological cutoff value(ECV) of amphotericin B showed that 52 strains were all wild type.Resistance rates of Candida tropicalis to fluconazole and voriconazole were 29.41％ and 17.64％ respectively, ECV of itraconazole and posaconazole showed that wild type accounted for 82.35％ and 94.12％ respectively;resistance rates of Candida albicans to fluconazol and voriconazole were 93.75％ and 81.25％ respectively, ECV of itraconazole and posaconazole showed that wild type accounted for 75.00％ and 81.25％ respectively;Candida parapsilosis complex strains were sensitive to both fluconazole and voriconazole, ECV of itraconazole and posaconazole showed that all were wild type;all Candida glabrata strains had intermediate resistance rates to fluconazole, ECV of voriconazole, itraconazole, and posaconazole showed that wild type accounted for 66.67％, 100.00％, and 100.00％ respectively.Conclusion Candida tropicalis is the most common pathogenic fungus causing candidemia in Nanchang of Jiangxi, followed by Candida albicans and Candida parapsilosis complex.Azole, echinocandin, and amphotericin B are still first-line antifungal agents.%目的 了解江西南昌市假丝酵母菌血症病原真菌构成及其药物敏感性.方法 收集 2015年3-10月南昌某医院住院患者送检血标本分离的假丝酵母菌属真菌,扩增真菌的转录间隔间区(ITS区)和核糖体大亚基(26rRNA、D1/D2区)对菌株进行鉴定,同时检测菌株对抗真菌药物的敏感性.结果 共收集血培养阳性标本1 332份,真菌阳性标本74份,占5.56％,其中检出假丝酵母菌属52株,以热带假丝酵母菌为最常见(17株,占32.69％),其次是白假丝酵母菌和近平滑假丝酵母菌复合体(均为16株,各占30.77％).ITS区和D1/D2区的鉴定结果相同.52株假丝酵母菌对米卡芬净、卡泊芬净均敏感,两性霉素B的流行病学折点(ECV)结果显示,均为野生型.热带假丝酵母菌对氟康唑和伏立康唑的耐药率分别为29.41％、17.64％,伊曲康唑和泊沙康唑的ECV结果显示,野生型分别占82.35％、94.12％;白假丝酵母菌对氟康唑和伏立康唑的敏感率分别为93.75％、81.25％,伊曲康唑和泊沙康唑的ECV显示,野生型分别占75.00％、81.25％;近平滑假丝酵母菌复合体对氟康唑和伏立康唑均敏感,伊曲康唑和泊沙康唑的ECV结果显示,均为野生型;光滑假丝酵母菌对氟康唑均为中介,伏立康唑、伊曲康唑和泊沙康唑的ECV结果显示,野生型分别占66.67％、100.00％、100.00％.结论 热带假丝酵母菌为江西南昌市假丝酵母菌血症最常见的病原真菌,其次是白假丝酵母菌和近平滑假丝酵母菌复合体,唑类和棘白菌素类抗真菌药物和两性霉素B仍是一线抗真菌药物.