239例外耳道真菌病的真菌菌种分布及药敏检测结果分析

Analysis of fungal distribution and drug susceptibility test in 239 cases of otomycosis

摘要:

目的 研究外耳道真菌病的真菌菌种分布及检测致病菌对抗真菌药物的敏感性。方法 本实验收集2020年4月—2021年11月，在荆州市中心医院耳鼻咽喉科门诊进行治疗的239例临床诊断为外耳道真菌病患者，对外耳道分离物，通过真菌形态学检查、沙式葡萄糖固体培养基(SDA)行真菌培养、DNA提取、ITS区PCR扩增及测序等行真菌菌种确定。行最低抑菌浓度(MIC)试验确定联苯苄唑(PCB)、特比萘芬(TRB)、克霉唑(CLO)和伊曲康唑(ITR)4种常见抗真菌药物的MIC。结果 本地区大部分外耳道真菌病致病菌为曲霉菌，其中最常见的为土曲霉，其次为黑曲霉、黄曲霉，少部分为念珠菌。大多数引起外耳道真菌病的致病菌对PCB和CLO耐药(MIC＞16 μg/mL)，绝大多数致病菌对TRB和ITR敏感。因此在治疗外耳道真菌病时应首选ITR和TRB类药物。结论 外耳道真菌病最常见的真菌致病菌属是曲霉菌和念珠菌。ITR和TRB是治疗外耳道真菌病的首选药物。

关键词:外耳道真菌病;菌种分布;药物敏感性试验;抗真菌药

Abstract:

Objective To study the distribution of fungal species in otomycosis and detect the drug sensitivity of pathogenic bacteria to antifungal drugs.Methods In this study, 239 patients with otomycosis were collected, who were treated in Department of Otolaryngology Head and Neck Surgery, Jingzhou Central Hospital from April 2020 to November 2021. Fungal species were identified by morphological examination, sand glucose solid medium (SDA) for fungal culture, DNA extraction, PCR amplification and sequencing in ITS region. Minimum inhibitory concentration (MIC) of bibenbenzazole (PCB), terbinafine (TRB), clotrimazole (CLO) and itraconazole (ITR) were determined by minimum inhibitory concentration test.Results Most of the pathogenic bacteria was Aspergillus in otomycosis. Aspergillus terreus was the most common pathogen of otomycosis, followed by Aspergillus Niger, Aspergillus flavus and candida. Most of the pathogenic bacteria causing otomycosis were resistant to PCB and CLO (MIC > 16 μg/ mL), and most of the pathogenic bacteria were sensitive to TRB and ITR. Therefore, ITR and TRB drugs should be the first choice in the treatment of otomycosis.Conclusions Aspergillus and Candida are the most common fungal pathogens of otomycosis. ITR and TRB are the first choice drugs for the treatment of otomycosis.

Key words:Otomycosis;Species distribution;Drug susceptibility test;Antifungal drugs