摘要
目的探讨上海市皮肤病医院浅部真菌感染患者念珠菌分离株的菌种分布及耐药性特征。方法收集2024年11月—2025年4月在上海市皮肤病医院(从腹股沟、趾甲、生殖器等部位)中分离到的144株念珠菌浅部真菌感染菌株,采用ITS区测序法进行分子鉴定,完成菌株的种属鉴定。依据CLSI M27-A4方案进行体外药敏试验。结果分离获得的144株病原菌中白念珠菌(54.2%)与近平滑念珠菌(33.3%)为主要优势菌株。白念珠菌对棘白菌素类和两性霉素B均高度敏感,但对氟康唑的耐药率达12.82%;近平滑念珠菌对多数抗真菌药物表现出高度敏感,棘白菌素类药物、伏立康唑和伊曲康唑均为100%敏感,氟康唑敏感率为89.58%。热带念珠菌对棘白菌素类药物和两性霉素B敏感,但对唑类药物表现出明显耐药趋势,3株对泊沙康唑全部为非野生型(菌株敏感性降低),氟康唑和伏立康唑各有1株耐药。季也蒙迈耶酵母、似平滑念珠菌及卡利比克迈耶酵母对所有药物基本敏感,耐药较少。皮肤皮状新丝孢酵母、异常威克汉姆酵母和汉逊德巴利酵母的多数菌株对抗真菌药物MIC较低,与之不同的是希木龙念珠菌对氟康唑(MIC高达128μg/mL)和特比萘芬(64μg/mL)显示出明显耐药倾向。皮肤癣状新丝孢酵母对棘白菌素类药物(8μg/mL)和5-氟胞嘧啶(16μg/mL)的MIC值偏高。结论浅部真菌感染念珠菌菌种分布以白念珠菌和近平滑念珠菌为主,菌种间耐药差异显著,建议加强种水平鉴定与耐药监测,以指导个体化治疗。
Objective To investigate the species distribution and antifungal susceptibility profiles of superficial Candida infections in Shanghai Skin Disease Hospital.Methods A total of 144 Candida isolates were collected from clinical specimens(including groin,nails,and genitalia)between November 2024 and April 2025.Species identification was performed using ITS(internal transcribed spacer)sequencing.Antifungal susceptibility testing was conducted in accordance with the CLSI M27-A4 guideline.Results Of the 144 pathogenic isolates,Candida albicans(54.2%)and Candida parapsilosis(33.3%)were the predominant species.C.albicans exhibited high susceptibility to echinocandins and amphotericin B,but showed a resistance rate of 12.82%to fluconazole.C.parapsilosis showed high susceptibility to most antifungal drugs,with 100%susceptibility to echinocandins,voriconazole,and itraconazole,and the 89.58%susceptibility to fluconazole.Candida tropical was susceptible to echinocandins and amphotericin B,but showed a significant resistance to azole drugs.All C.tropical isolates exhibited reduced susceptibility(non-wild-type)to posaconazole,with one isolate resistant to fluconazole and one to voriconazole.Meyerozyma guilliermondii,Candida metapsilosis and Meyerozyma caribbica were mostly susceptible to antifungal drugs,with less resistance observed.Most strains of C.haemulonii,C.dermatis,Wickerhamomyces anomalus,and Debaryomyces hansenii also exhibited low MIC values across antifungal drugs tested.However,C.haemulonii showed a significant resistance tendency to fluconazole(with MIC 128μg/mL)and terbinafine(64μg/mL).C.dermatis had elevated MICs to echinocandins(8μg/mL)and 5-fluorocytosine(16μg/mL).Conclusion C.albicans and C.parapsilosis are the leading pathogens in superficial candidiasis.The significant interspecies differences in antifungal susceptibility observed necessitates species-level identification and ongoing resistance surveillance to guide effective individualized therapy.
作者
刘美
何文婧
李璐璐
谭静文
杨连娟
LIU Mei;HE Wenjing;LI Lulu;TAN Jingwen;YANG Lianjuan(Department of Medical Mycology,Center of Infectious Skin Diseases,Shanghai Skin Disease Hospital,Tongji University School of Medicine,Shanghai 200443,China)
出处
《中国真菌学杂志》
2025年第6期658-663,共6页
Chinese Journal of Mycology
基金
国家自然科学基金(82173429)。
关键词
浅部真菌感染
念珠菌药敏
真菌药敏试验
念珠菌菌种分布
superficial fungal infections
Candida drug sensitivity
fungal drug sensitivity analysis
distribution of Candida species
