289株VVC致病菌的菌种分布和对9种抗真菌药物敏感性

外阴阴道念珠菌病（vulvovaginal candidiasis,VVC）是女性的常见病。本研究收集了2018年1月-12月苏州地区VVC患者分离的289株念珠菌进行了病原学鉴定和包括棘白菌素类、新三唑类药物在内的9种抗真菌药物体外敏感性分析。本文采用核糖体RNA的D1/D2基因进行念珠菌菌种鉴定。参照M27-A3方法检测其对9种抗真菌药物（包括棘白菌素类及新三唑类药物）的体外敏感性。结果表明,289株VVC念珠菌菌株中,白念珠菌259株、光滑念珠菌14株、克柔念珠菌10株、热带念珠菌4株、近平滑念珠菌2株。259株VVC白念珠菌对棘白菌素类体外敏感性好,对米卡芬净敏感性高于另外两种棘白菌素类;对两性霉素B、5-氟胞嘧啶、氟康唑敏感性好;但对伊曲康唑、伏立康唑敏感性差;对泊沙康唑敏感性好。光滑念珠菌株和克柔念珠菌分离株对卡泊芬净敏感性差,但对米卡芬净、阿尼芬净敏感性好;光滑念珠菌株对两性霉素B、5-氟胞嘧啶体外敏感性好,对伊曲康唑敏感性差,对泊沙康唑敏感性好;伏立康唑对光滑念珠菌分离株MIC₅₀/₉₀为0.5/1μg/mL;克柔念珠菌对伊曲康唑、伏立康唑50%耐药;4株热带念珠菌对伊曲康唑50%耐药,对卡泊芬净、氟康唑、伏立康唑100%耐药,对其余5种抗真菌药物敏感。近平滑念珠菌对9种抗真菌药物均敏感。白念珠菌仍为苏州地区VVC的主要病原菌,其次是光滑念珠菌和克柔念珠菌,它们对临床常用药物伊曲康唑、伏立康唑、卡泊芬净敏感性差。研究结果提示对VVC病人常规进行分泌物培养、菌种鉴定,对苏州地区临床医生制定VVC治疗方案具有重要参考价值。尽管棘白菌素类、两性霉素B、5-氟胞嘧啶、新三唑类药物尚未应用到VVC的临床治疗中,但是这些药物对VVC病原体总体敏感性较好,未来有望成为氟康唑、咪唑类药物治疗失败患者的新选择。

Identification of 289 isolates of VVC pathogens and sensitivity of the pathogens to 9 antifungal drugs

Vulvovaginal candidiasis (VVC) is a common disease in women. In this study, 289 isolates of Candida spp. were obtained from VVC patients in Suzhou from January to December 2018. Identification and the test of in vitro susceptibility to nine antifungal drugs including echinocandins and neotriazoles of the pathogens were couducted. The D1/D2 gene of ribosomal RNA was used to identify Candida species. The in vitro sensitivity was tested by using M27-A3 protocol. Among 289 isolates, there were 259 isolates of Candida albicans, 14 isolates of Candida glabrata, 10 isolates of Candida krusei, 4 isolates of Candida tropicalis, and 2 isolates of Candida parapsilosis. Candida albicans showed high sensitivity to echinocanins in vitro, and its sensitivity to micafungin was higher than that to the other two echinocandins tested. It is sensitive to amphotericin B, 5-fluorocytosine and fluconazole, but less sensitive to itraconazole and voriconazole; it is also sensitive to posaconazole. Candida glabrata and Candida krusei have poor sensitivity to caspofungin, but have high sensitivity to micafungin and anidulafungin. The sensitivity of Candida glabrata to amphotericin B, 5-fluorocytosine and posaconazole is high, but poor to itraconazole. The MIC_50/90 of Candida glabrata isolate to voriconazole is 0.5/1μg/mL in vitro. Candida krusei reveals 50% resistance to itraconazole and voriconazole; 4 isolates of Candida tropicalis display 50% resistance to itraconazole and 100% resistance to caspofungin, fluconazole, and voriconazole, and are sensitive to other 5 antifungal drugs. Candida parapsilosis was sensitive to 9 antifungal drugs. Candida albicans is predominant pathogen causing VVC in Suzhou, while Candida glabrata and Candida krusei. Secondary, showing lower sensitivity to itraconazole, voriconazole and caspofungin. The results indicate that periodical routine secretion examination culture and identification of pathogens are of benefit to local clinicians in Suzhou to develop a proper VVC treatment plan. Although echinomycin, amphotericin B, 5-fluorocytosine, and neotriazole have not been applied to the clinical treatment of VVC, these drugs are generally more sensitive to VVC pathogens and are expected to become a new choice for VVC patients.