目的: 研究上海市嘉定区真菌性阴道炎的病原体分布及药敏情况,为该病的临床诊治提供指导意见。方法: 收集2015年7月至2016年6月,上海市嘉定区中心医院、上海市嘉定区妇幼保健院、上海市嘉定区中医医院、上海市嘉定区南翔医院、上海市嘉定区安亭医院5家医院妇产科确诊为真菌性阴道炎患者的1 097份白带标本,进行培养鉴定及药敏试验。结果: 不同医院间病原体的分布情况差异无统计学意义,以白念珠菌为主（占81.5%）,其中光滑念珠菌为非白念珠菌中构成比最高的菌种（14.6%）,而复发患者白念珠菌的构成比为67.0%。所有菌株对氟康唑、伏立康唑和伊曲康唑敏感率分别为98.9%、92.0%和70.0%,而白念珠菌和非白念珠菌对以上3种药物的敏感率分别为99.6%、92.6%、72.4%和84.8%、89.2%、59.1%;不同医院间检出的病原体对伏立康唑和伊曲康唑敏感率差异有统计学意义（P<0.05）。结论: 上海市嘉定区真菌性阴道炎的病原体以白念珠菌为主,但复发患者的病原体分布呈现多样性趋势;部分病原体对伊曲康唑出现了较为明显的耐药现象;各菌种间和调查医院间的药物敏感率差异也存在统计学意义;强化真菌性阴道炎的病原学检查和药物敏感试验有助于指导临床治疗。
Objective: To investigate the distribution and drug sensitivity of pathogens of fungal vaginitis in Jiading District of Shanghai for providing a guidance for clinical diagnosis and treatment of the disease. Methods: Altogether 1 097 leucorrhea specimens were collected from patients with fungal vaginitis in obstetrics and gynecology department from 5 hospitals(Jiading District Central Hospital, Maternal and Child Health Hospital, Jiading District Hospital of Traditional Chinese Medicine, Nanxiang Hospital and Anting Hospital), from July 2015 to June 2016. The specimens were cultured and drug sensitivity test was performed. The results were analyzed by SPSS 13.0. Results: There was no significant difference in distribution of pathogens among these hospitals, and Candida albicans was the most common (81.5%). The highest proportion (14.6 percent) of non-Candidaalbicans was found in Candidaglabrata. The proportion of Candida albicans in recurrent patients was 67.0%. Overall sensitive rates of all strains to fluconazole, voriconazole and itraconazole were 98.9%, 92.0% and 70.0%, respectively. The sensitivity of Candida albicans and non-Candida albicans to 3 azoles were 99.6%, 92.6%, 72.4% and 84.8%, 89.2% and 59.1%, respectively. For hospital, the five hospitals showed significant differences in sensitivity of drugs in the case of voriconazole and itraconazole. Conclusions: Candida albicans is the main pathogen of fungal vaginitis in Jiading District of Shanghai. The distribution of pathogens in patients with recurrent fungal vaginitis shows a trend of diversity. Some pathogens appeare with more obvious itraconazole resistance. There are also differences in drug sensitivity among the strains and different hospitals. To emphasize the pathogen examination and drug sensitivity test of fungal vaginitis is helpful for clinicians to prescribe better clinical treatment.
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