本文選題：侵襲性真菌病 + 酵母菌　； 參考：《北京協(xié)和醫(yī)學(xué)院》2014年碩士論文

【摘要】：[目的]分析中國醫(yī)院侵襲性真菌監(jiān)測網(wǎng)(CHIF-NET)第三年度中所收集酵母菌菌株的流行病學(xué)及藥物敏感性,以及CHIF-NET前三年度菌株流行病學(xué)及藥物敏感性變化趨勢。 [方法]CHIF-NET第三年度(CHIF-NET12)參加單位22家。所收集的1619株菌株在中心實驗室統(tǒng)一使用分子生物學(xué)方法鑒定到種水平,并使用美國臨床和實驗室標(biāo)準(zhǔn)協(xié)會(CLSI)紙片擴散法測定對氟康唑、伏立康唑的藥物敏感性。此外,回顧性分析CHIF-NET前三年度連續(xù)參加監(jiān)測的11家醫(yī)院的數(shù)據(jù),并使用YeastOne比色微量肉湯稀釋法測定9種抗真菌藥物對相應(yīng)醫(yī)院所有非白念珠菌的最小抑菌濃度(MIC)。 [結(jié)果]CHIF-NET12收集的所有菌種中,念珠菌屬菌株最為常見,占所收集菌株的91.8%。其次為隱球菌屬6.5%、毛孢子菌屬0.6%,其他菌屬占1.2%。念珠菌屬菌株在大部分標(biāo)本類型中常見,其中在血標(biāo)本分離菌株中占94.4%。但在腦脊液標(biāo)本中隱球菌屬更為常見(66.4%)。與分子鑒定結(jié)果相比,原始鑒定結(jié)果的準(zhǔn)確率為87.3%；常見念珠菌種原始鑒定準(zhǔn)確率較高(80%),但少見念珠菌種和少見酵母菌屬鑒定總準(zhǔn)確率低。白念珠菌仍是最常見的念珠菌菌種,但分離比50%。最常見的非白念珠菌分別為熱帶念珠菌(18.0%)、近平滑念珠菌復(fù)合體(16.2%)、光滑念珠菌復(fù)合體(12.0%)。隱球菌屬中,97.1%為新型隱球菌復(fù)合體。不同醫(yī)院引起侵襲性真菌感染的酵母菌種屬分布具有較為明顯的院際間差異。根據(jù)CLSI紙片擴散法藥敏測試結(jié)果,絕大部分白念珠菌、熱帶念珠菌、近平滑念珠菌復(fù)合體菌株對氟康唑敏感(91%)。11.8%的光滑念珠菌菌株對氟康唑耐藥,其中大部分為伏立康唑非野生型�？巳崮钪榫鷮Ψ⒖颠蛎舾行暂^好(91.7%)。部分少見菌種對氟康唑或/和伏立康唑敏感性低。回顧CHIF-NET10-12連續(xù)參加監(jiān)測的11家醫(yī)院,菌種共計2367株,分子鑒定共發(fā)現(xiàn)43個菌種。三年中,念珠菌屬、隱球菌屬和其他少見菌屬分離比例沒有顯著的變化。三年中白念珠菌的分離比例持續(xù)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-念珠菌種的總比例下降,比例由55.0%至46.5%(p=0.001),與國際趨勢相反。其中,最為顯著的是近平滑念珠菌分離比例的下降。近平滑念珠菌對所有藥物敏感性好,但棘白菌素類MIC值偏高。熱帶念珠菌對唑類藥物的交叉耐藥以及光滑念珠菌對部分棘白菌素類藥物的耐藥值得關(guān)注。棘白菌素類藥物對隱球菌屬、毛孢子菌屬活性差。部分醫(yī)院有少見菌種,特別是一些耐藥少見菌種的集中出現(xiàn),其流行趨勢需要持續(xù)關(guān)注。 [結(jié)論]CHIF-NET三年監(jiān)測積累了大量珍貴的菌種及臨床信息資源。統(tǒng)一的分子生物學(xué)鑒定方法和標(biāo)準(zhǔn)的藥物敏感性測定方法在監(jiān)測中是必要的。本項研究的數(shù)據(jù)很大程度上填補了國內(nèi)相關(guān)領(lǐng)域的空白。但三年的時間尚短,仍需要進一步持續(xù)的監(jiān)測以進一步觀察我國引起侵襲性真菌病酵母菌的流行病學(xué)及藥物敏感性變化趨勢。
[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.

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R519

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