中国侵袭性酵母菌病病原菌的流行病学及药物敏感性研究

发布时间：2018-04-25 11:24

本文选题：侵袭性真菌病 + 酵母菌　；参考：《北京协和医学院》2014年硕士论文

【摘要】：[目的]分析中国医院侵袭性真菌监测网(CHIF-NET)第三年度中所收集酵母菌菌株的流行病学及药物敏感性,以及CHIF-NET前三年度菌株流行病学及药物敏感性变化趋势。 [方法]CHIF-NET第三年度(CHIF-NET12)参加单位22家。所收集的1619株菌株在中心实验室统一使用分子生物学方法鉴定到种水平,并使用美国临床和实验室标准协会(CLSI)纸片扩散法测定对氟康唑、伏立康唑的药物敏感性。此外,回顾性分析CHIF-NET前三年度连续参加监测的11家医院的数据,并使用YeastOne比色微量肉汤稀释法测定9种抗真菌药物对相应医院所有非白念珠菌的最小抑菌浓度(MIC)。 [结果]CHIF-NET12收集的所有菌种中,念珠菌属菌株最为常见,占所收集菌株的91.8%。其次为隐球菌属6.5%、毛孢子菌属0.6%,其他菌属占1.2%。念珠菌属菌株在大部分标本类型中常见,其中在血标本分离菌株中占94.4%。但在脑脊液标本中隐球菌属更为常见(66.4%)。与分子鉴定结果相比,原始鉴定结果的准确率为87.3%；常见念珠菌种原始鉴定准确率较高(80%),但少见念珠菌种和少见酵母菌属鉴定总准确率低。白念珠菌仍是最常见的念珠菌菌种,但分离比50%。最常见的非白念珠菌分别为热带念珠菌(18.0%)、近平滑念珠菌复合体(16.2%)、光滑念珠菌复合体(12.0%)。隐球菌属中,97.1%为新型隐球菌复合体。不同医院引起侵袭性真菌感染的酵母菌种属分布具有较为明显的院际间差异。根据CLSI纸片扩散法药敏测试结果,绝大部分白念珠菌、热带念珠菌、近平滑念珠菌复合体菌株对氟康唑敏感(91%)。11.8%的光滑念珠菌菌株对氟康唑耐药,其中大部分为伏立康唑非野生型。克柔念珠菌对伏立康唑敏感性较好(91.7%)。部分少见菌种对氟康唑或/和伏立康唑敏感性低。回顾CHIF-NET10-12连续参加监测的11家医院,菌种共计2367株,分子鉴定共发现43个菌种。三年中,念珠菌属、隐球菌属和其他少见菌属分离比例没有显著的变化。三年中白念珠菌的分离比例持续上升,在酵母菌中比例由35.4%上升到了42.5%(p=0.001)；相比之下非白念珠菌-念珠菌种的总比例下降,比例由55.0%至46.5%(p=0.001),与国际趋势相反。其中,最为显著的是近平滑念珠菌分离比例的下降。近平滑念珠菌对所有药物敏感性好,但棘白菌素类MIC值偏高。热带念珠菌对唑类药物的交叉耐药以及光滑念珠菌对部分棘白菌素类药物的耐药值得关注。棘白菌素类药物对隐球菌属、毛孢子菌属活性差。部分医院有少见菌种,特别是一些耐药少见菌种的集中出现,其流行趋势需要持续关注。 [结论]CHIF-NET三年监测积累了大量珍贵的菌种及临床信息资源。统一的分子生物学鉴定方法和标准的药物敏感性测定方法在监测中是必要的。本项研究的数据很大程度上填补了国内相关领域的空白。但三年的时间尚短,仍需要进一步持续的监测以进一步观察我国引起侵袭性真菌病酵母菌的流行病学及药物敏感性变化趋势。
[Abstract]:[Objective] to analyze the epidemiology and drug sensitivity of the yeast strains collected from the invasive fungal monitoring network (CHIF-NET) of Chinese Hospital (CHIF-NET), and the trend of epidemiology and drug sensitivity in the first three years of CHIF-NET.
[methods]CHIF-NET third (CHIF-NET12) participated in 22 units. 1619 strains of strains collected were identified in the central laboratory using molecular biological methods to identify the species level, and the drug sensitivity of fluconazole and voriconazole was measured by the American clinical and Laboratory Standard Association (CLSI) paper diffusion method. In addition, a retrospective analysis of CHIF-NET was made. The data of 11 hospitals were continuously monitored in the previous three years, and the minimal inhibitory concentration (MIC) of 9 antifungal drugs on all non Candida albicans in the corresponding hospital was measured by the YeastOne colorimetric micro broth dilution method.
[results among all the strains collected by]CHIF-NET12, Candida strains are the most common, and the 91.8%. of the collected strains is 6.5% and 0.6% of the genus Cryptococcus, and the other strains of the genus 1.2%. are common in most of the specimen types, including 94.4%. in the isolated strains of blood and Cryptococcus in the cerebrospinal fluid. More common (66.4%). Compared with the molecular identification results, the accuracy of the original identification results was 87.3%, the accuracy rate of the common Candida species was higher (80%), but the identification of rare Candida and rare yeast was low. Candida albicans was still the most common Candida strain, but the most common non Candida albicans was isolated from 50%.. Candida tropicalis (18%), nearly smooth Candida complex (16.2%), smooth Candida complex (12%). Cryptococcus neoformans, 97.1% are new cryptococcal complexes. The distribution of yeast species in different hospitals caused by invasive fungal infection has significant inter hospital differences. According to the results of drug sensitivity test of CLSI paper diffusion method, the vast majority of them Candida albicans, Candida tropicalis, Candida albicans sensitive to fluconazole (91%).11.8% was resistant to fluconazole, most of which were Fushita Yasu non wild type. The sensitivity of Candida Kurus to Fushita Yasu was better (91.7%). Some of the strains were less sensitive to fluconazole or / and Fushita Yasu. Review C There were 2367 strains of HIF-NET10-12 in 11 continuous monitoring hospitals, and 43 strains were identified by molecular identification. In three years, the separation ratio of Candida, Cryptococcus and other rare species did not change significantly. In three years, the proportion of Candida albicans continued to rise from 35.4% to 42.5% (p=0.001) in the yeast. The proportion of non Candida albicans decreased from 55% to 46.5% (p=0.001), in contrast to the international trend. Among them, the most significant is the decline in the proportion of Candida albicans. Candida albicans is sensitive to all drugs, but the MIC value of echinocinomycin is high. The cross resistance of Candida tropics to the azolics And the drug resistance of Candida smooth to some echinococcosis. Acanthomycin is poor in the activity of cryptococcosis and hairy spore. In some hospitals, there are rare strains in some hospitals, especially some rare species of drug-resistant bacteria, and the trend of the epidemic needs continuous attention.
[conclusion the three year monitoring of]CHIF-NET has accumulated a large number of valuable bacterial and clinical information resources. A unified molecular biological identification method and a standard method for the determination of drug sensitivity are necessary for monitoring. The data of this study largely fill the gaps in the domestic related fields. But the three years are still short and still need to be further held. Continuous monitoring to further observe the epidemiology and drug sensitivity of yeast strains causing invasive fungal disease in China.

【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R519

【共引文献】