生殖道念珠菌病病原真菌的调查及药敏试验

目的了解本地区生殖道念珠菌病病原真菌构成及其体外药敏试验情况。方法采用科玛嘉念珠菌显色培养基和YBC鉴定卡对患者1164份生殖道标本的致病真菌进行分离和鉴定,并用ROSCO纸片扩散法检测分离菌株对制霉菌素、酮康唑、氟康唑、伊曲康唑、咪康唑和特比萘芬的药敏情况。结果共分离9种295株念珠菌,其中自念珠菌为85．76％,近平滑念珠菌为7．46％,光滑念珠菌为3．39％,其他念珠菌为3．39％。295株念珠菌对制霉菌素、酮康唑、氟康唑、伊曲康唑、咪康唑和特比萘芬的敏感性分别为99．66％、97．29％、89．83％、72．22％、46．44％和36．61％。结论本地区生殖道念珠菌病患者致病菌分布以白念珠菌为主,体外药敏显示制霉菌素、酮康唑和氟康唑有较好的敏感性。     

重症监护病房白念珠菌耐药性8年变化趋势

目的调查上海长征医院重症监护室(ICU)近8 a中临床分离白念珠菌的耐药性变化,为临床治疗提供参考。方法上海长征医院ICU 2002～2009年从414例患者中首次分离出414株白念珠菌,对其中277株进行药敏试验。采用Cox-Stuart趋势检验回顾性分析临床分离真菌中白念珠菌所占比例变化趋势和白念珠菌对常用抗真菌药物耐药率的变化趋势。结果 2002～2009年间,上海长征医院ICU白念珠菌分离株数从2002年的34株增加至2009年的92株,但白念珠菌占总真菌分离株数的百分比维持在34.6%～55.7%,P=0.03。白念珠菌对于5-氟胞嘧啶和两性霉素B平均耐药率分别为4.0%和0.7%,对其他常用抗真菌药的耐药率依次为咪康唑47.0%、酮康唑10.8%、伊曲康唑19.9%、特比萘芬42.6%、氟康唑14.6%及伏立康唑13.0%。白念珠菌对5-氟胞嘧啶和两性霉素B和伊曲康唑耐药率的8年变化无统计学差异。结论上海长征医院ICU近8 a来白念珠菌仍然为临床较为常见的真菌分离株,但白念珠菌占总分离株数的百分比有逐渐减少的趋势。白念珠菌对常用抗真菌药物耐药性均无明显变化趋势。     

广州地区生殖系统念珠菌感染的菌型及其体外药敏分析

目的 了解性传播疾病病人中生殖系统念珠菌感染的菌型及其对临床常用抗真菌药物的敏感性.方法 采用法国梅里埃公司的ATB ID32C酵母菌鉴定反应板鉴定菌种并使用Rosco纸片扩散法进行体外药敏检测,比较不同菌型念珠菌的药敏情况.结果 临床131例生殖系统念珠菌感染者中,白色念珠菌116例(88.55％)、近平滑念珠菌7例(5.34％)、光滑念珠菌5例(3.82％)、季也蒙念珠菌2例(1.53％)、克柔念珠菌1例(0.76％).药敏分析结果:念珠菌属对制霉菌素(96.18％)、酮康唑(90.84％)、氟康唑(70.23％)敏感,而对咪康唑(31.30％)、嗌康唑(31.30％)、伊曲康唑(47.33％)和特比奈酚(7.63％)的中度敏感性和耐药性比较高.结论 生殖系统念珠菌感染以白色念珠菌为主,感染的念珠菌除了对多烯类药物敏感率高外,对唑类抗真菌药有不同程度的交叉耐药,不同菌型其药敏谱存在差异.     

118株口腔致病念珠菌病原学特征及药敏结果分析

目的调查分析临床致病口腔念珠菌菌种分布及对氟康唑、伊曲康唑、制霉菌素、5-氟胞嘧啶和酮康唑的药物敏感性,以提供临床用药依据。方法收集口腔真菌感染患者标本,常规涂片镜检、培养,对酵母样生长菌落用生物梅里埃公司API20AUX进行菌种鉴定。对其中的念珠菌进行药敏分析。结果共收集141例临床口腔真菌病标本,其中118株念珠菌中,白念珠菌87株（73.7%）,热带念珠菌15株（12.7%）,高里念珠菌6株（5.1%）,光滑念珠菌4株,其他念珠菌6株。口腔念珠菌对氟康唑、伊曲康唑、制霉菌素、5-氟胞嘧啶和酮康唑的耐药率分别为5.1%、1.7%、0%、3.4%、5.1%。结论解放军324医院口腔真菌感染主要为长期应用抗生素的老年患者。口腔念珠菌病仍以白念珠菌为主,对常用抗真菌药物呈不同程度的耐药,应进行真菌常规菌种鉴定及药敏试验。     

婴幼儿皮肤黏膜念珠菌病临床特点及其病原菌体外药敏分析

目的分析并探讨婴幼儿皮肤黏膜念珠菌病的临床特点,检测其病原菌对常用抗真菌药物的体外敏感性。方法入选105例0～3岁皮肤黏膜念珠菌病的患儿,均经临床表现及真菌学检查确诊,用调查表收集患儿有关资料,统计并分析患儿的临床特点。用科玛嘉显色培养基及API20AU测试卡鉴定菌种。参照CLSI酵母菌检测方案M27-A3测定菌株对咪康唑、益康唑、酮康唑、联苯苄唑及特比萘芬等5种药物的体外敏感性。结果 105例婴幼儿皮肤黏膜念珠菌病年龄分布为0.4～36个月,平均10.67个月,以1岁以内感染最多(75%)。皮损位于尿布区最多,其次为颈部及腋下。共分离念珠菌189株,菌种鉴定显示白念珠菌最多(81.5%),其次为近平滑念珠菌(10.6%)和光滑念珠菌(3.2%)。咪康唑和酮康唑对白念珠菌的MIC_(90)值最小(0.25μg/mL)。酮康唑和益康唑对所有菌株包括非白念珠菌的MIC_(90)值分别为0.25μg/mL和2μg/mL。联苯苄唑和特比萘芬对白念珠菌的MIC_(90)值最大(16μg/mL),对非白念珠菌的MIC_(90)值分别为8μg/mL和16μg/mL。结论婴幼儿皮肤黏膜念珠菌病的年龄分布以1岁内为主,皮损主要位于尿布区、颈部和腋下等温暖潮湿部位。白念珠菌仍是婴幼儿皮肤黏膜念珠菌病中最常见的菌种,非白念珠菌中以近平滑念珠菌为主。咪康唑和酮康唑是治疗婴幼儿皮肤黏膜念珠菌病较好的外用药选择,尤其是酮康唑。     

广州地区生殖系统念珠菌感染的菌型及其体外药敏分析

【摘 要】 目的 了解性传播疾病病人中生殖系统念珠菌感染的菌型及其对临床常用抗真菌药物的敏感性。 方法 采用法国梅里埃公司的ATB ID32C酵母菌鉴定反应板鉴定菌种并使用Rosco纸片扩散法进行体外药敏检测,比较不同菌型念珠菌的药敏情况。 结果 临床131例生殖系统念珠菌感染者中,白色念珠菌116例（88.55%）、近平滑念珠菌7例（5.34%）、光滑念珠菌5例（3.82%）、季也蒙念珠菌2例（1.53%）、克柔念珠菌1例（0.76%）。药敏分析结果：念珠菌属对制霉菌素（96.18%）、酮康唑（90.84%）、氟康唑（70.23%）敏感,而对咪康唑（31.30%）、嗌康唑（31.30%）、伊曲康唑（47.33%）和特比奈酚（7.63%）的中度敏感性和耐药性比较高。 结论 生殖系统念珠菌感染以白色念珠菌为主,感染的念珠菌除了对多烯类药物敏感率高外,对唑类抗真菌药有不同程度的交叉耐药,不同菌型其药敏谱存在差异。     

我国外阴阴道念珠菌病致病菌菌种分布及体外药敏研究现状

目的回顾性分析我国外阴阴道念珠菌病致病菌的菌种分布及体外药敏研究情况。方法检索分析万方、中国知网、维普、Pubmed等数据库15年来中国外阴阴道念珠菌病致病菌的菌种分布和体外药敏相关文献资料。结果共计检索筛选60篇文献,从现有数据来看,不同地区妇科患者中VVC的患病率为10%~40%,平均为20.3%;各地研究显示外阴阴道念珠菌病的主要病原体是白念珠菌,约占70%~90%,非白念珠菌以光滑念珠菌为主;非白念珠菌在复发性外阴阴道念珠菌病的病原体中所占比例更大。大多数研究显示氟康唑、制霉菌素、两性霉素B体外抗真菌活性较高,外阴阴道念珠菌病分离的念珠菌对氟康唑敏感率在70%~98%左右,对制霉菌素、两性霉素B的敏感率超过95%;过半的研究显示外阴阴道念珠菌病分离的念珠菌对伊曲康唑敏感性高;对5-FC、酮康唑的药敏结果各地差异较大。结论对VVC患者进行病原学鉴定和体外药敏检查十分重要,尤其是难治性VVC、复发性VVC患者,若发现病原菌为非白念珠菌,应根据体外药敏结果适当调整方案,可以选用非氟康唑类药物如AmB外用制剂、硼酸胶囊等;而对于大多数由白念珠菌引起的VVC,应用传统药物如氟康唑、制霉菌素、伊曲康唑等仍是较好的选择,酮康唑、5-FC等药物不建议作为常规选择。     

光动力疗法治疗甲真菌病的临床研究进展CSCD

甲真菌病(onychomycosis)是由皮肤癣菌、酵母菌及非皮肤癣菌性丝状真菌侵犯甲板/床引起的一种常见皮肤病。流行病学调查显示,甲真菌病的发病率占自然人群的2%~18%,全国多中心流行病学调查皮肤科门诊就诊足病患者中甲真菌病患者的比例为15.7%[1]。目前,甲真菌病的系统治疗主要依靠口服抗真菌药物如特比萘芬、伊曲康唑和氟康唑等,但这些药物在治疗中仍存在一些问题,包括服药周期较长、患者依从性差、药物不良反应和相互作用风险,以及有可能导致耐药等[2-3]。     

4种抗真菌药物对糖尿病大鼠血糖的影响

目的观察酮康唑、氟康唑、伊曲康唑和特比萘芬与胰岛素组合使用以及单独使用时对糖尿病大鼠血糖水平的影响。方法建立糖尿病大鼠模型,随机分为10组,每组5只。前4组皮下注射胰岛素的同时分别喂食4种抗真菌药物;第5组单独皮下注射胰岛素;第6—9组分别喂食4种抗真菌药物;第10组既不注射胰岛素也不喂食抗真菌药物。定时对糖尿病大鼠尾静脉采血,使用CX5PRO生化检测仪对其血糖进行检测。结果酮康唑、氟康唑和伊曲康唑分别与胰岛素合用时,可使糖尿病大鼠血糖降低（P〈0．05）;不与胰岛素合用时,氟康唑和伊曲康唑均可使糖尿病大鼠血糖升高（P〈0．05）;特比萘芬无论是否与胰岛素合用,对糖尿病大鼠的血糖水平均无影响（P〉0．05）。结论唑类抗真菌药物无论是否与胰岛素合用均会影响糖尿病大鼠的血糖水平,特比萘芬无论是否与胰岛素合用,都不会影响糖尿病大鼠的血糖水平。     

贵州省某区域女性阴道念珠菌的菌种分布及耐药性分析

目的探讨贵州省某区域女性阴道分泌物标本分离念珠菌的菌种分布特点及耐药性,为临床治疗提供参考。方法收集2018年1月～12月贵州省某区域2055名女性病例,进行阴道分泌物念珠菌的分离培养、鉴定及药敏试验,并对结果进行统计分析。结果共分离并鉴定出非重复念珠菌543株,以白念珠菌分离率居首位,占40.5%,光滑念珠菌和近平滑念珠菌位居第2、3位(35.0%、19.7%);感染患者以26～30年龄段最多见(39.2%),其次为21～25年龄段(25.4%)和31～35年龄段(19.2%),21～40年龄段患者占90.4%。不同念珠菌对抗真菌药物的耐药情况相差较大,未见米卡芬净、制霉菌素和卡泊芬净耐药念珠菌。非白念珠菌对伊曲康唑、氟康唑和酮康唑的耐药率均明显高于白念珠菌(P0.01),对5-氟胞嘧啶的的耐药率无明显差异(P0.05)。结论贵州省该区域女性阴道念珠菌感染以白念珠菌多见,不同念珠菌的耐药情况具有差异,临床应根据不同病原菌耐药特点制定合理的治疗计划。     

濮阳市部分浅部真菌病中癣菌和念珠菌混合感染的分析

目的了解濮阳地区部分浅部真菌病中两种及两种以上真菌混合感染的情况。方法对临床确诊为浅部真菌病的患者456例,取标本行10%KOH直接镜检、真菌培养及菌种鉴定。登记确诊患者相关临床资料,分析其中混合感染的发病特点。结果确诊皮肤癣菌和念珠菌混合感染病例36例,分离率为7.89%,多见于股部(58.33%)和足部(27.78%);分离菌株72株,皮肤癣菌中以红色毛癣菌为主(75.00%),念珠菌中以非白念珠菌为主(72.22%)。结论濮阳地区部分浅部真菌病中混合感染主要为皮肤癣菌和念珠菌的混合感染,多见于股部和足部;致病菌以红色毛癣菌和非白念珠菌为主。     

临床酵母样真菌的感染特点及耐药性研究

目的了解临床酵母样真菌的感染类型、分布以及耐药情况,为临床诊断治疗提供合理的用药依据.方法采用常规方法进行真菌培养,用科玛嘉显色培养基联合法国生物梅里埃API 20C AUX鉴定条进行鉴定,药敏试验采用微量稀释法.结果864株酵母样真菌中,白色念珠菌619株（71.6%）,其次为热带念珠菌116株（13.4%）和克柔念珠菌47株（5.4%）,非白色念珠菌感染的比例逐年上升（21.5%）.其中,呼吸道标本酵母样真菌检出率最高,达79.7%,其次是消化道为8.8%,泌尿道为4.7%.科室分布依次为干部科、呼吸科、急诊内科、血液科等;白色念珠菌对两性霉素B、5-氟胞嘧啶高度敏感,达90%以上,对氟康唑和伊曲康唑的敏感性有所降低.结论酵母样真菌的检出率与患者基础疾病密切相关;对氟康唑等药物的敏感性有下降的趋势,未发现对4种药物同时耐药的菌株,提示在治疗中,药敏监测是非常必要的.     

复发性外阴阴道念珠菌病的致病菌种鉴定及药敏分析

目的：探究复发性外阴阴道念珠菌病致病菌的菌种分布及耐药情况,指导临床治疗。方法：收集210例念珠菌性外阴阴道炎患者阴道分泌物标本,其中复发性外阴阴道念珠菌病（RVVC）组76例,外阴阴道念珠菌病（VVC）组134例。运用科玛嘉显色培养基法进行菌种鉴定和药物敏感试验。结果：在210例病例中,RVVC组中白色念珠菌54株（71.05%）,光滑念珠菌15株（19.74%）,热带念珠菌4株（5.26%）,克柔念珠菌2株（2.63%）,近平滑念珠菌1株（1.32%）。非白色念珠菌中以光滑念珠菌为主,在RVVC组中的比例明显高于VVC组,有显著性差异（P〈0.05）。药敏试验显示,RVVC的念珠菌株中仅8株对7种药物全部敏感,23株敏感药物〈5种,其中1株仅对制霉菌素敏感;对药物的敏感率为制霉菌素（97.37%）〉克霉唑（60.52%）〉酮康唑（51.32%）〉伊曲康唑（36.84%）〉咪康唑（35.53%）〉氟康唑（23.68%）〉特比奈芬（10.53%）。结论：白色念珠菌仍是RVVC的主要致病菌,非白色念珠菌比例在RVVC组中显著高于VVC组,其中以光滑念珠菌为主。念珠菌对制霉菌素敏感率最高,对唑类药物耐药性有增加趋势。     

血流感染真菌的分布及耐药性分析

目的了解真菌性血液感染常见病原真茵的菌群分布及耐药性状况,为临床真菌感染性疾病提供病原学诊断和合理使用抗真菌药物的依据。方法回顾性分析浙江大学医学院附属第一医院5年（2008-2012年）间导致真菌性血液感染的217株真菌的菌群分布及药物敏感性状况。结果217株真菌标本中以假丝酵母菌属为主,占88. 5%;其中又以白假丝酵母菌比例最高,占35.4%。菌种分布与患者的性别和年龄存在相关性。60-79岁年龄组感染白假丝酵母菌多见,占49% ,这一比例明显高于其他真菌。男性更容易感染白假丝酵母菌（40.1% vs 24.6%,P〈0.05）,女性感染近平滑假丝酵母菌更常见（24.6% vs 11.8%,P〈0.05）.假丝酵母菌和新生隐球菌对两性霉素B、伏立康唑、氟康唑、伊曲康唑、5-氟胞嘧啶的敏感性均较高。光滑假丝酵母菌对伊曲康唑敏感率较低,仅为60.0%。结论真菌血流感染在临床呈上升趋势,抗真菌药物均体现较高抗菌活性,对真菌感染进行地区层面流行病学调查和耐药监测很重要。     

In vitro resistance to fluconazole and itraconazole in clinical isolates of Candida spp and Cryptococcus neoformans

An in vitro susceptibility testing of 181 strains of six species of Candida and 21 strains of Cryptococcus neoformans was carried out in order to investigate the resistance to new antifungal drugs. We have studied clinical isolates from 200 different patients of Hospital del Mar (Barcelona) and Hospital La Inmaculada (Almería). An agar diffusion method (NeoSensitabs, Rosco, Taastrup, Denmark), was employed with fluconazole, itraconazole, and reference drugs amphotericin B, flucytosine, tioconazole and ketoconazole. A high level of susceptibility was found for amphotericin B in C. neoformans strains while 19% of them were resistant to flucytosine. All the strains of C. neoformans and Candida guilliermondii were susceptible to the new azoles derivatives and also Candida parapsilosis and Candida albicans had a great susceptibility to this antifungals. A greater level of resistance was found for Candida krusei, Candida tropicalis and Candida glabrata to fluconazole, itraconazole and ketoconazole, but resistance to fluconazole and itraconazole is not always linked because ten resistant strains for fluconazole were susceptible to itraconazole, and two other resistant to itraconazole were susceptible to fluconazole.     

Species distribution, antifungal susceptibility and clonal relatedness of Candida isolates from patients in neonatal and pediatric intensive care units at a medical center in Turkey

The aim of this study was to assess species distribution, antifungal susceptibility and clonal relationships among Candida strains isolated from a group of pediatric/neonatal intensive care (PICU/NICU) patients that had a very high mortality rate (76%). The cases of 21 patients (19 with candidemia, 2 with Candida meningitides) treated over a 1-year period in a Turkish hospital PICU and NICU were retrospectively analyzed. Twenty-eight Candida isolates were detected from blood (20), cerebrospinal fluid (CSF) (2) and other specimens (6). Candida species were identified using the API ID 32C System. Susceptibility testing was done (all 28 isolates) for amphotericin B, fluconazole and itraconazole using the broth microdilution method. Arbitrarily primed polymerase chain reaction (AP-PCR) was used for molecular typing of the 3 most common ones; C. albicans (15), C. parapsilosis (6), and C. pelliculosa (4). Electrophoretic karyotyping (EK) was done to check clonal identity obtained by AP-PCR. Of the 20 blood isolates, 8 (40%) were C. albicans, 12 (60%) were non-albicans Candida, and one of the 2 CSF isolates was C. albicans. The overall species distribution was as follows: 15 C. albicans isolates, 6 C. parapsilosis isolates, 4 C. pelliculosa isolates, 2 C. famata isolates and 1 C tropicalis isolate. Amphotericin B had the best antifungal activity with a MIC90 of 0.125 microg/ml, and the rates of susceptibility to fluconazole and itraconazole were 93% and 82%, respectively. AP-PCR revealed 11 genotypes (4 were identical pairs, 7 were distinct) among the 15 C. albicans isolates, 2 genotypes (5 were classified in the same type) among the 6 C. parapsilosis isolates, and 4 separate genotypes for the 4 C. pelliculosa isolates. Karyotyping results correlated well with the AP-PCR findings. As indicated in the previous research, our results confirmed that non-albicans Candida species have become more frequently causative agents for invasive fungal infections in the ICU. Transmission of C. albicans and C. pelliculosa was relatively low, but transmission of C. parapsilosis was high, suggesting that more effective control and very strict treatment protocols are needed for patients having high mortality and invasive fungal infection in ICU.     

慢性前列腺炎患者假丝酵母菌感染及耐药性分析

目的 了解慢性前列腺炎与假丝酵母菌感染的相关性及假丝酵母菌的耐药性。方法 采用常规沙堡平板分离360例慢性前列腺炎患者的前列腺液标本中的假丝酵母菌,疑似菌落用ATB Expression鉴定仪进行鉴定。采用ATB-Fungus真菌药敏板,对假丝酵母菌株进行药敏试验。结果 11．7％前列腺液标本（42／360）似丝酵母菌阳性,其中自假丝酵母菌23例（54．7％）,近平滑假丝酵母菌13例（30．9％）,其它6例（14．3％）。假丝酵母菌菌株对两性霉素B和制霉菌素敏感率均为100％,其次为酮康唑,敏感率为97．0％;对5-氟胞嘧啶耐药性最强,其耐药率为56．5％。结论 白假丝酵母菌和近平滑假丝酵母菌是慢性前列腺炎假丝酵母菌感染的优势菌种,假丝酵母菌株最敏感的药物是两性霉素B和制霉菌素。     

Drug sensitivity of Candida in patients with kidney diseases receiving immunosuppressive therapy

It was shown that prednisolone and its combination with azathioprine++ increased contamination of the patients with yeast-like fungi and promoted development of candidiasis in them to a greater extent than cyclophosphamide. In the patients treated with the immunodepressants there was observed a carrier state in regard to various yeast-like fungi: 12 species belonging to 6 genera were isolated from the pathological materials. Determination of sensitivity to antifungal drugs in 200 Candida strains revealed that amphotericin B was the most active agent. Then followed mycoheptin, nystatin and nitroxolin. Levorin was the least active drug. The MICs of the drugs for the majority of the cultures were 0.5, 4-8, 8-16 and 32-64 micrograms/ml respectively. Candida resistant strains (mainly to levorin and mycoheptin) were isolated only from recipients of kidney transplants during the early postoperative period when the patients were subjected to intensive immunodepressive and prophylactic antifungal therapy. Among the fungi of the Candida genus C. guillermondii and C. parapsilosis proved to be the most resistant. Under the hospital conditions and in vitro studies it was found that cyclophosphamide and combinations of prednisolone with cytostatics increased resistance of Candida to the antifungal drugs. Rapid increasing of the fungi resistance to levorin and mycoheptin was observed. The increase in the resistance to amphotericin B was somewhat lower and that to nitroxolin and nystatin was extremely low. The study of the combined effect of the immunodepressants and antifungal drugs demonstrated that the immunodepressants increased the antifungal activity of amphotericin B, levorin and nitroxolin.(ABSTRACT TRUNCATED AT 250 WORDS)