哈尔滨地区假丝酵母菌DNA异质性及药物敏感性分析

研究假丝酵母菌的DNA异质性及药物敏感性,为预防和监控院内假丝酵母菌感染奠定基础。将临床分离的假丝酵母菌菌株,用科玛嘉显色培养基鉴定菌种,经纸片扩散法进行药敏试验,应用随机扩增多态性DNA（RAPD）技术对这些菌株进行基因分型。结果显示：93株假丝酵母菌中白假丝酵母菌68株,非白假丝酵母菌25株,所有菌株对制霉菌素,两性霉素B两种药物的敏感率最高（100％）,酮康唑其次（70．9％）,氟康唑的敏感率最低（50．5％）,引物1和引物2将来源不同的68株白假丝酵母菌分别分成4型（A1、B1、C1、D1）和6型（A2、B2、C2、D2、E2、F2）。哈尔滨地区的假丝酵母菌感染以白假丝酵母菌为主,且主要为A1、B1型（引物1）或A2、B2型（引物2）;基因型与药敏谱无明显相关性。     

150例酵母样真菌的菌种分布及其耐药性分析

目的分析引起医院酵母样真菌感染的菌种分布及其耐药性,以指导临床合理用药。方法对2007年10月-2008年10月的住院患者送至真菌室所分离的150株酵母样真菌,采用血清学鉴定及API 20C AUX酵母样真菌鉴定试剂条进行鉴定,采用ATB FUNGUS3进行药敏试验。结果分离到150株酵母样真菌,其中自假丝酵母菌94株（62．67％）,光滑假丝酵母菌14株（9．33％）,热带假丝酵母菌12株（8．00％）,无名假丝酵母菌10株（6．67％）,季也蒙假丝酵母菌6株（4．00％）,近平滑假丝酵母菌6株（4．00％）,其他酵母菌8株（5．33％）。以呼吸内科（54．67％）、老年科（9．33％）、皮肤性病科（9．33％）、血液科（8．67％）分离率最高。150株酵母菌对5氟胞嘧啶（5-FC）、两性霉素B（AmB）、氟康唑（FCA）、伊曲康唑（ITR）、伏立康唑（VRC）的敏感菌株分别为144、150、131、104、147株,敏感率分别为96．00％、100％、87．33％、69．33％、98．00％。结论真菌感染的因素有很多,临床分布科室广泛,临床上应重视真菌检测及真菌药敏试验,根据检测结果合理应用抗真菌药物。     

泌尿系感染真菌菌种分布及耐药性分析

目的 了解引起泌尿系感染真菌菌种分布及其耐药特点。方法 用沙保弱培养基进行真菌分离培养,鉴定用API20CAUX生化系列,药敏用ATBFUNGUS药敏板。结果427株真菌中前5位为白色假丝酵母菌215株、热带假丝酵母菌69株、伪热带假丝酵母菌38株、克柔假丝酵母菌27株、光滑球拟酵母菌23株。5-氟胞嘧啶、两性霉索B、制霉菌素、咪康唑、益康唑、酮康唑的敏感性分别为90．2％、90．2％、89．2％、73．8％、71．4％和62．9％。临床感染真菌种类及其耐药性有逐年上升趋势。结论 引起泌尿系感染的真菌广泛存在,但仍以白色假丝酵母菌为主。对5-氟胞嘧啶、两性霉索B、制霉菌素敏感率较高;唑类抗真菌药的敏感性呈明显下降趋势。     

医院内假丝酵母菌感染菌种的分布及耐药分析

目的了解医院内假丝酵母菌感染菌种的分布及抗真菌药物的耐药谱,为临床抗真菌治疗提供正确数据。方法采用VITEK-32微生物自动鉴定仪进行假丝酵母菌菌种的鉴定,同时用ATB FUNGUS真菌药敏条作药敏试验。结果从住院患者的血液、痰、尿、分泌物、胆汁等标本中共检出真菌505株。其中白假丝酵母菌281株,热带假丝酵母菌124株,光滑假丝酵母菌21株,季也蒙假丝酵母菌17株,近平滑假丝酵母菌16株,克柔假丝酵母菌10株,皱折假丝酵母菌8株,异常汉逊假丝酵母菌6株,5氟-胞嘧啶和两性霉素抑菌效果最好,其耐药率分别为2.8%和3.4%。其他4种抗真菌药物制霉菌素、氟康唑、伊曲康唑和酮康唑的耐药率分别为6.1%、13.7%、9.3%和28.3%。结论医院假丝酵母菌感染耐药率逐年上升,非白假丝酵母菌感染明显增加。氟康唑对白假丝酵母菌有很强的抗菌活性且毒副作用小。假丝酵母菌感染的迅速增加同广泛应用超广谱抗菌药物、激素及免疫抑制剂等有关。假丝酵母菌感染死亡率高,因此早期诊断及有效性治疗是减少死亡率的关键。     

男性生殖道真菌感染菌种构成及耐药分析

目的探讨男性生殖道真菌感染病原菌的种类构成及耐药性,为临床治疗提供依据。方法采集2367份男性患者生殖道分泌物立即送检采用法国生物梅里埃公司Vitek2-Compact进行菌种鉴定以及ATB FUNGUS3真菌药敏试剂条进行药敏试验。结果 2 367例男性生殖道炎症患者中,共检出真菌410例,检出率为17.32%,其中白色假丝酵母菌303株,占73.90%;近平滑假丝酵母菌75株,占18.29%;热带假丝酵母菌16株,占3.90%;4种假丝酵母菌对两性霉素B的敏感率为100.00%;白色假丝酵母菌和热带假丝酵母菌对伏立康唑、氟康唑、依曲康唑耐药率分别为1.65%、1.32%、7.59%和12.50%、12.50%、18.75%。结论假丝酵母菌在男性生殖道感染中占有一定比例;菌种以白色假丝酵母菌为主,近平滑假丝酵母菌次之。因为它们对唑类抗真菌药物有不同程度的耐药,所以临床应加强假丝酵母菌的检测和药敏分析,合理选用药物。     

皮肤性病门诊生殖道酵母菌阳性结果分析

摘要：目的 探讨生殖道假丝酵母菌阳性率、药敏情况及耐药趋势,为临床合理选用抗真菌药物提供最新的依据。方法 按照《全国临床检验操作规程》,采用法国梅里埃生物公司API-20C酵母菌鉴定板、ATB-Funguns酵母菌药敏板对2012年1月至2014年12月培养生殖道酵母菌阳性的标本进行鉴定及药敏试验。结果 1 419例生殖道分泌物分离出114例假丝酵母菌,感染率为8.0%,其中白假丝酵母菌101例占88.60%,感染率最高,其他非白假丝酵母菌13例占11.40%;药敏结果表明,假丝酵母菌对5-氟胞嘧啶、两性霉素B具有较高敏感性（92.11%、100.00%）,对氟康唑、伊曲康唑、伏立康唑呈现不同程度的耐药;101例白假丝酵母菌对5-氟胞嘧啶、两性霉素B的敏感性分别为93.07%、100.00%,未出现对两性霉素B的耐药菌株。结论 皮肤性病门诊生殖道酵母菌分离株仍以白假丝酵母菌为主,白假丝酵母菌对氟康唑、伊曲康唑、伏立康唑的耐药率呈上升趋势;微生物实验室应加强对假丝酵母菌株的分离鉴定及耐药性监测,为临床医生准确合理地使用抗真菌药物提供病原学依据。     

致念珠菌性包皮龟头炎白假丝酵母菌对9种抗真菌药物最低抑菌浓度测定

目的检测引起念珠菌性包皮龟头炎的白假丝酵母菌对9种抗真菌药物MIC,为临床治疗念珠菌性包皮龟头炎提供参考依据。方法常规培养分真菌,并鉴定到种,采用最低抑菌浓度法对白假丝酵母菌进行体外药物敏感试验。结果培养分离的12株菌中,白假丝酵母菌占75.00%,白假丝酵母菌生物变种占16.67%,近平滑假丝酵母菌占8.33%;11株白假丝酵母菌耐药率由高到低依次是氟康唑,伊曲康唑,咪康唑,酮康唑,克霉唑,益康唑,5-氟胞嘧啶啶,两性霉素B,制霉菌素,其中6种药物耐药率大于50%。结论白假丝酵母菌仍是造成念珠菌性包皮龟头炎最常见的致病菌,耐多药现象较为普遍,应根据临床实验室的体外药敏试验结果,指导临床合理用药。     

妇科住院患者酵母样真菌感染的菌株分布与药敏研究

目的对妇科住院患者阴道分泌物酵母样真菌隐性感染的菌群分布与药敏结果进行回顾性分析,为临床围手术期合理使用抗真菌药物提供依据。方法妇科住院患者5813例阴道分泌物中分离到396株酵母样真菌,采用API-20Aux和ATBFUNGUS进行鉴定和药敏试验。结果396株酵母样真菌中,分离率最高的前3位是白色假丝酵母菌（59.6%）、光滑假丝酵母菌（21.2%）和接合假丝酵母菌（6.6%）。酵母样真菌对5-氟胞嘧啶（5-FC）、两性霉素B（AMB）和制霉菌素（NYS）敏感率最高,达90.7%、92.7%和96.2%,咪康唑（MIC）、益康唑（ECO）和酮康唑（KET）分别为74.2%、61.6%和69.4%。结论住院妇科患者阴道分泌物酵母样真菌隐性感染主要以白色念珠菌和光滑念珠菌为主,感染的酵母样真菌对5-FC、AMB和NYS的药物敏感性较高,对唑类抗真菌药则有不同程度的耐药率。     

皮肤性病门诊生殖道酵母菌阳性结果分析

目的探讨生殖道假丝酵母菌阳性率、药敏情况及耐药趋势,为临床合理选用抗真菌药物提供最新的依据。方法按照《全国临床检验操作规程》,采用法国梅里埃生物公司API-20C酵母菌鉴定板、ATB-Fungus酵母菌药敏板对2012年1月至2014年12月培养生殖道酵母菌阳性的标本进行鉴定及药敏试验。结果 1 419例生殖道分泌物分离出114例假丝酵母菌,感染率为8.0%,其中白假丝酵母菌101例占88.60%,感染率最高,其他非白假丝酵母菌13例占11.40%;药敏结果表明,假丝酵母菌对5-氟胞嘧啶、两性霉素B具有较高敏感性(92.11%、100.00%),对氟康唑、伊曲康唑、伏立康唑呈现不同程度的耐药;101例白假丝酵母菌对5-氟胞嘧啶、两性霉素B的敏感性分别为93.07%、100.00%,未出现对两性霉素B的耐药菌株。结论皮肤性病门诊生殖道酵母菌分离株仍以白假丝酵母菌为主,白假丝酵母菌对氟康唑、伊曲康唑、伏立康唑的耐药率呈上升趋势;微生物实验室应加强对假丝酵母菌的分离鉴定及耐药性监测,为临床医生准确合理地使用抗真菌药物提供病原学依据。     

假丝酵母菌尿路感染临床观察及耐药性分析

目的 调查和分析尿路感染假丝酵母菌的分布及耐药情况,为临床合理选用抗菌药物提供依据.方法 尿液采用经典型浸片Uricult培养,使用ATB-Fungus板条进行药敏试验,利用WHONET 5.6对浙江萧山医院2008年1月至2012年12月间尿培养分离菌株及药敏结果进行回顾性分析.结果 共分离出假丝酵母菌273株,其中白假丝酵母菌占37.4％,光滑假丝酵母菌28.9％、热带假丝酵母菌27.8％;临床分离数量以ICU(58)最多,其次为泌尿外科(50)和内科(49).药敏结果显示:两性霉素B、5-氟胞嘧啶对白假丝酵母菌、热带假丝酵母菌和光滑假丝酵母菌仍保持较强的抗菌活性,敏感率≥98.6％,伏立康唑敏感率≥86.3％.结论 尿路感染分离得到的假丝酵母菌以白假丝酵母菌为主,其次为光滑假丝酵母菌和热带假丝酵母菌;两性霉素B、5-氟胞嘧啶对假丝酵母菌保持较强的抗菌活性,是治疗假丝酵母菌感染的首选药物.临床应重视假丝酵母菌的培养和其药敏试验,根据药敏结果科学合理使用抗真菌药物.     

血培养分离出212株念珠菌的菌种分布及耐药性分析

目的分析血培养分离出的念珠菌的菌种分布及耐药分析,为临床念珠菌血症的诊治提供理论依据。方法回顾性分析2017年1月—2020年12月期间,本院血培养分离出的念珠菌的菌种分布、药敏试验结果及患者血培养分离出念珠菌前后96 h内的G试验结果。结果血培养中分离出念珠菌314例,阳性率2.1%,其中非重复分离株212例。检出率最高的是近平滑念珠菌(72株,34.0%),其次是白念珠菌(55株,25.9%)和光滑念珠菌(28株,13.2%)。念珠菌检出率最高的科室为ICU(62株,29.2%),其次是新生儿科(39株,18.4%)和血液科(20株,9.4%)。检出的212株念珠菌除一株近平滑念珠菌为两性霉素B的非野生株,其余均为两性霉素B的野生株。白念珠菌对唑类药物的敏感率超过90%。但光滑念珠菌和热带念珠菌对唑类药物的敏感性较低。血培养分离出念珠菌的前后96 h内,G试验的阳性率为73.7%。结论本院念珠菌检出率前3位分别是近平滑念珠菌、白念珠菌和光滑念珠菌。光滑念珠菌、热带念珠菌对唑类药物敏感性比较低,在经验用药时需要合理选择抗真菌药物。G试验对念珠菌血症有较高的价值,需要对结果进行动态监测。     

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.     

ATB FUNGUS2法在念珠菌属和新生隐球菌抗真菌药敏试验中应用的评价

目的评价ATBFUNGUS2半固体培养基法在测定念珠菌属和新生隐球菌对4种常用抗真菌药物敏感性中的应用价值。方法利用CLSIM27．A2微量液基稀释法和ATBFUNGUS2法同时测定131株念珠菌和20株新生隐球菌对两性霉素B（AmB）、氟康唑（FLC）、氟胞嘧啶（5-Fc）和伊曲康唑（ITC）的敏感性。结果①两种方法对于AmB、5-FC、FLC和ITC的一致性分别为98％、89．4％、78．8％和78．1％;②所有受试菌株中两种方法的一致性为80％,但ATBFUNGUS2法将2／5株M27-A2法检查为FLC耐药的白念珠菌判断为敏感或剂量依赖,将8／10株M27-A2法检查为FLC剂量依赖的白念珠菌判断为敏感或耐药。③ATBFUNGUS2法中AmB的MIC值判读范围偏高,以致于实际工作中不能读出准确的值。结论ATBFUNGUS2半固体培养基法在测定念珠菌属和新生隐球菌对4种常用抗真菌药物的敏感性时不失为简单、快速而且重复性好的方法。     

Species distribution and antifungal susceptibility profile of Candida spp. bloodstream isolates from Latin American hospitals

From March 1999 to March 2000, we conducted a prospective multicenter study of candidemia involving five tertiary care hospitals from four countries in Latin America. Yeast isolates were identified by classical methods and the antifungal susceptibility profile was determined according to the National Committee for Clinical Laboratory Standards microbroth assay method. During a 12 month-period we were able to collect a total of 103 bloodstream isolates of Candida spp. C. albicans was the most frequently isolated species accounting for 42% of all isolates. Non-albicans Candida species strains accounted for 58% of all episodes of candidemia and were mostly represented by C. tropicalis (24.2%) and C. parapsilosis (21.3%). It is noteworthy that we were able to identify two cases of C. lusitaniae from different institutions. In our casuistic, non-albicans Candida species isolates related to candidemic episodes were susceptible to fluconazole. Continuously surveillance programs are needed in order to identify possible changes in the species distribution and antifungal susceptibility patterns of yeasts that may occurs after increasing the use of azoles in Latin American hospitals.     

白念珠菌临床分离调查及基因分型研究

目的 了解白念珠菌临床分离情况,并探讨其药敏结果与基因分型的相关性.方法 回顾性分析本院2011年3～11月间临床分离白念珠菌分布及耐药性;随机选取232株,采用PCR方法扩增白念珠菌25S rDNA基因内含子区进行基因分型研究;采用ATB真菌药敏试剂条进行药敏分析;统计分析药敏结果与基因分型的相关性.结果 期间共检出酵母样真菌973例,占病原菌阳性样本数比率为15.7％ (973/6196);其中分离白念珠菌562株,占58％ (562/973),主要分布科室为呼吸科(39.1％)、老年科(13.2％)、ICU(7.7％)、神经内科(7.5％)、免疫科(6.0％)以及其他科室(26.5％);标本类型以下呼吸道为主(81.7％),其次为尿路(9.4％)、血液(1.8％)等.对氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑及伏立康唑的耐药率分别为0.9％、0％、1.4％、1.6％和1.1％.随机选取的232株白念珠菌经PCR方法可分为3型:A型125株,B型96株,C型11株.各型在5种药物的耐药性上并无差异.结论 临床分离酵母样真菌以白念珠菌为主,感染部位以下呼吸道为主;临床分离株对5种抗真菌药物敏感度较高,主要基因型为A和B型,不同基因分型间药敏结果并无统计学差异.     

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.     

In vitro antifungal susceptibility of clinical isolates of Candida spp. obtained from patients with different predisposing factors to candidosis

The increase in the number of infections caused by Candida species and the consequent use of antifungal agents favours an increase of resistant isolates. The aim of this study was to evaluate the antifungal susceptibility of Candida spp. isolates from patients with different systemic predisposing factors to candidosis. Seventy-nine Candida spp. isolates were assayed for in vitro susceptibility to amphotericin B, fluconazole, 5-flucytosine and itraconazole using the technique proposed by the Clinical and Laboratory Standards Institute (CLSI). Four C. albicans, one C. guilliermondii, four C. parapsilosis and two C. tropicalis isolates were resistant to amphotericin B. Only two isolate was resistant to itraconazole. All the isolates tested were susceptible to fluconazole and flucytosine. It could be concluded that the most efficient drugs against the Candida isolates studied were fluconazole and flucytosine and that all of the antifungal agents used in this study were effective against the Candida spp. isolates tested.     

Multicenter survey of in vitro antifungal resistance in yeasts of medical importance isolated from Spanish patients

Twelve Spanish laboratories collected 325 yeast clinical isolates during a 30 day's period, among them 224 Candida albicans, 30 Candida glabrata, and 27 Candida parapsilosis. In vitro antifungal susceptibility to amphotericin B, ketoconazole, fluconazole and itraconazole was determined by an agar diffusion test (Neo-Sensitabs, Rosco, Denmark). All the isolates tested were susceptible in vitroto amphotericin B and nearly all (97.2%) to itraconazole. In vitrosusceptibility to fluconazole and ketoconazole was high (90.2% and 91.4% of isolates, respectively) but showed variations depending on the species tested. Resistance to fluconazole and ketoconazole was low in C. albicans (4% and 3%, respectively), but 30% of Candida guilliermondii and 36% of C. glabrata isolates were resistant to fluconazole. Ketoconazole resistance was observed in 40% of C. glabrata, and 17% of Candida tropicalis. Resistance to antifungal drugs is very low in Spain and it is related to non-C. albicans isolates.     

Study of acute vulvovaginitis in sexually active adult women, with special reference to candidosis, in patients of the Francisco J. Muñiz Infectious Diseases Hospital

The results of microbiological vaginal secretions samples obtained from 749 women (from July 2001 to July 2002) were studied in the Bacteriology Unit of the Francisco Javier Mu?iz Hospital from Buenos Aires. All patients suffered acute vulvovaginitis were child bearing and sexually active women, 334 of them were HIV-positive. The following are the results of the microbiological studies: Lactobacillus spp 50.6%, Gardnerella vaginalis 25.6%, Candida spp 17.4%, Trichomonas vaginalis 5.3%, Neisseria gonorrhoeae 0.3% and B group Streptococcus 0.8%. Candida vaginitis was significantly more frequent in HIV-positive patients, (21.6% vs 14%; p = 0.0086); meanwhile, trichomoniasis was less common although the difference was not statistically significant (3.6 vs 6.7%, p = 0.0810). The following Candida species were isolated in this study: Candida albicans 76.8%, Candida glabrata 15.6%, Candida parapsilosis 2.9%, Candida tropicalis 1.5% and Candida krusei 0.7%. Eight cases (6.2%) of vaginitis were produced by two Candida species (C. albicans and C. glabrata), and in three cases (2.17%) Saccharomyces cerevisiae were isolated. Five women suffering acute vaginitis with Candida spp presented another etiologic agent of vaginal infection, three cases T. vaginalis and two cases G. vaginalis. The following are some of the most important findings of this study: 1) Half of the patients presented a normal microbial biota; 2) Candida spp vaginitis was significantly more frequent among HIV-positive women; 3) we observed a high incidence of Candida glabrata infections (15.9%), 4) 6.2% of vaginal candidiasis were caused by more than one Candida species and, 5) the susceptibility pattern of C. albicans and C. glabrata isolates against fluconazole was similar to the one observed in other studies. The majority of C. albicans isolates were susceptible to fluconazole (MIC90 = 0.5 microg/ml) meanwhile C. glabrata strains were much less susceptible to this drug (MIC50 and MIC90 = 32 microg/ml).