男性尿道炎和包皮龟头炎致病真菌的分布与药敏分析

目的了解男性念珠菌性尿道炎和包皮龟头炎的菌群分布及体外抗真菌药敏试验情况。方法菌株分离均来自复旦大学附属华山医院皮肤性病门诊临床症状轻重不一、真菌直接镜检阳性的61例患者。用科玛嘉念珠菌显色培养基及API 20C AUX鉴定系统进行菌种鉴定;采用CLSIM27-A2肉汤微量稀释法对61株临床分离念珠菌作了氟康唑、两性霉素B、氟胞嘧啶、伊曲康唑、伏立康唑、特比萘芬6种抗真菌药物敏感性测定。结果对培养阳性的61例菌株,通过科玛嘉念珠菌显色培养基及API 20C AUX鉴定系统作菌种鉴定,白念珠菌52例（85.2%）,近平滑念珠菌3例,光滑念珠菌2例,热带念珠菌2例,季也蒙念珠菌1例,克柔念珠菌1例。对52株白念珠菌的药敏试验显示氟康唑98.1%敏感,1.9%剂量依赖性敏感;氟胞嘧啶96.2%敏感,3.8%耐药;伊曲康唑44.2%敏感,40.5%剂量依赖性敏感,15.3%耐药;伏立康唑84.6%敏感,15.4%耐药;两性霉素B全部敏感;特比萘芬的MIC范围为1-64μg/ml,MIC50和MIC90皆为64μg/ml。结论在男性念珠菌性尿道炎和包皮龟头炎中,白念珠菌仍是第一位致病菌,体外药敏试验显示氟康唑、伏立康唑、氟胞嘧啶、两性霉素B对男性念珠菌性尿道炎均有较好的敏感性。

Distribution and drug susceptibility of pathogenic fungi from male urethritis and balanoposthifis

Objective To explore distribution and susceptibility of pathogenic fungi isolated from male candidal urethritis and balanoposthifis. Methods Isolates from patients with typical clinical symptoms and positive fungal microscopy examination were collected. CHROM agar candida medium and API 20C AUX were used to identify Candida species. Minimum inhibition concentrations of 61 Candida isolates to six antifungal agents were tested by microdilution broth method according to the CLSI M27-A2. Results Fiftytwo isolates were C. albicans ,3 Candida parapsilsis ,2 Candida glabrata ,2 Candida tropicalis , 1 C. guilliermondi and 1 C. krusei . The MIC and susceptible rate of 52 C. albicans isolates to six antifungal agents were as follows ： fluconazole 98.1% susceptible, 1. 9% susceptible dose dependent; 5-flucytosine 96.2% susceptible,3.8% resistant; itraconazole 44.2% susceptible ,40.5% susceptible dose dependent, 15.3% resistant; voriconazole 84.6% susceptible, 15.4% resistant; amphotericin B 100% susceptible; terbinafine 1 - 64 μg/ml, MIC50 and MIC90 were 64 μg/ml. Conclusions In the male candidal urethritis and balanoposthifis, the main species of pathogenic yeasts is C. albicans , which was susceptible to fluconazole, voriconazole, amphotericin B and 5-flucytosine.