目的: 探讨包头地区外阴阴道念珠菌病(vulvovaginal candidiasis,VVC)患者感染念珠菌菌种分布特点及对抗真菌药物的敏感性,为临床精准治疗提供参考。方法: 收集2021年1月至12月295例VVC患者阴道分泌物进行分离培养,应用MALDI-TOFMS、PCR方法完成菌种鉴定,按照CLSI M27-S4标准采用微量肉汤稀释法进行9种药物体外药敏试验。结果: 感染患者以31~35年龄段最多见(30.85%),其次是26~30年龄段(20.34%),21~40年龄段患者占82.04%,性生活、妊娠等易感因素在VVC中占比较大;共分离鉴定出非重复菌株295株,白念珠菌居首位占79.32%,光滑念珠菌次之占13.90%,尼瓦利亚、布加拉等少见念珠菌共7种各1株;白念珠菌对伊曲康唑的耐药率高于非白念珠菌(P＜0.01),二者对氟康唑、伏立康唑和泊沙康唑耐药情况差异无统计学意义(P＞0.05),非白念珠菌对卡泊芬净和5-氟胞嘧啶的耐药率高于白念珠菌(P＜0.01);未发现制霉菌素耐药菌株,所有菌株对两性霉素B的敏感性均为100%,对特比奈芬的耐药率均很高。结论: 包头地区VVC患者感染菌种多样,以白念珠菌多见,但不同菌种念珠菌对常用抗真菌药物敏感情况差异较大,应定期进行持续的耐药监测,以便指导妇科医生制订正确的诊疗方案,同时延缓耐药性的产生。
Objective: to investigate the distribution of candidiasis in patients with vulvovaginal candidiasis (VVC) in Baotou area and the susceptibility to antifungal drugs, so as to provide reference for accurate clinical treatment. Methods: The vaginal secretions of 295 patients with VVC from January to December 2021 were collected for isolation and culture. MALDI-TOFMS and PCR were used to complete the identification of strains. According to the CLSI M27-S4 standard, the in vitro drug sensitivity test of 9 drugs was carried out by microbroth dilution method. Results: The patients with infection were most common in the 31-35 age group (30.85%), followed by the 26-30 age group (20.34%), and the 21-40 age group accounted for 82.04%. Sexual life, pregnancy and other susceptible factors accounted for a large proportion in VVC. A total of 295 non-repetitive strains were isolated and identified, of which Candida albicans ranked the first (79.32%), followed by Candida glabrata (13.90%), and 7 rare Candida species such as Nivalia and Bugala (1 strain in each). The resistance rate of Candida albicans to itraconazole was higher than that of non-Candida albicans (P＜0.01), while there was no significant difference in the resistance of fluconazole, voriconazole and posaconazole between the two groups (P＞0.05). The resistance rate of non-Candida albicans to caspofungin and 5-fluorocytosine was higher than that of Candida albicans (P＜0.01). No nystatin-resistant strains were found. The sensitivity of all strains to amphotericin B was 100%, and the resistance rate to terbinafine was high. Conclusion: VVC patients in Baotou area are infected with various strains, especially Candida albicans, but the susceptibility of different strains to common antifungal drugs is quite different. Regular and continuous drug resistance monitoring should be carried out to guide gynecologists to formulate correct diagnosis and treatment plans and delay the emergence of drug resistance.
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