| Objective To study on the distribution of all the fungi collected in Pekin Union Medical College Hospital (PUMCH) from 1999 to 2005. And study on the gene relatedness of strains isolated from ICU and strains isolated from the same patients and different sample type or different sampling date. Comparing with strains collected in Tangshan City RenMing hospital in order to study on the candida gene relatedness of different areas.Methods The data of fungi isolated from PUMCH from 1999 to 2005 were collected and analyzed. Candida albicans and Candida tropicalis collected in PUMCH from 1999 to 2005 were re-identified by Chrom Agar Candida medium and API 20C AUX system, and then the fungi genotype were analyzed by Rep-PCR and RAPD. Candida strains collected in the same patient and different sample type or different sampling date were analyzed by the methods of Rep-PCR and RAPD, and the strains collected in Tangshan City RenMing hospital in 2005 were also analyzed by RAPD.ResultsDistributions of fungi isolated in PUMCH from 1999 to 2005:It's markedly increased of the fungi(total of 1727 to 8533) from 1999 to 2005, the positive sample is 554 in 1999 and increased to 2848 in 2005, the proportion of the positive sample is 25.3 %～41.5 %. The positive patient number is 324 in 1999 and increased to 2010 in 2005, the percent is from 17.3% to 28.5%.The quantity of Candida albicans is 177 in 1999 and increased to 736 in 2005, and Candida tropicalis is from 53 to 171, Candida glabrata is from 45 to 188, Aspergillus fumigatus is from 5 to 144, Aspergillus flavus is from 0 to 85. The proportion of Candida albicans is 35%～55%, Candida glabrata is 6.7%～14.5%, Candida tropicalis is 8.3%～16.4%, Candida krusei is 1.2%～4.1%, Candida parapsilosis is 0.3 %～1.6%. Aspergillus fumigatus is increased from 1.5% in 1999 to 7.2% in 2005. Aspergillus flavus is increased from 0% in 1999 to 4.2% in 2005. Candida krusei is 36 in 2002 and is the highest (the proportion is 4.1%) among the 7 years. All the fungi species is decreased in 2003 because of SARS. Different sample types have different isolates' distributions: In blood sample Candida albicans is the most, others are Candida tropicalis, Candida parapsilosis, Candida glabrata and Cryptococcus neoformans; In broncho-alveolar lavage sample Candida albicans is the most, others are Penicillium, Aspergillus fumigatus and Candida glabrata. In urine and vagina, the most is Candida albicans, the second is Candida glabrata and Candida tropicalis. Cryptococcus neoformans is the most in cerebrospinal fluid, and then Candida albicans and Candida tropicalis. In respiratory tract the most is Candida albicans, the second is Candida tropicalis and Candida glabrata.Total of the blood sample is 4884 in 1999 and increased to 11287 in 2005. The total positive sample(including bacteria) is 358 in 1999 and increased to 1265 in 2005, the proportion is 7.3% in 1999 and increased to 11.6% in 2002, and is invariable from 2001 to 2005(the proportion is 10.1%～13.8%), decreased(10.1%) in 2003 perhaps because of SARS. The positive sample of fungi is 11 in 1999 and rose to 106 in 2005, the proportion of the positive is increased from 1999 to 2002(from 3.1% to 10.1%), decreased slighlyt in 2003 and 2004, and increased in 2005. The positive patient number of fungi is 8 in 1999 and rose to 47 in 2005.The positive isolate in blood total is 226, of them 53 isolates are collected clinical data, including 24 of female and 29 of male. average age is 52.4, of them 19 is in surgical ward, 20 is in ICU or MICU, 2 is in hematology, 21 is in tumor, 41 is in surgical therapy,, 28 is presence of a central venous catheter, 35 is in drainage.We also found Cryptococcus neoformans on eyes and found Scedosporium apiospermum in joint fluid.The gene relatedness results of Candida albicans and Candida tropicalis by RAPD and Rep-PCR methods:Candida albican collected from ICU in 2004 displayed 5 genotypes by RAPD and 3 genotypes by Rep-PCR. Candida albican collected from ICU in 2005 displayed 4 genotypes (type B including B1 and B2 subtypes) by RAPD and displayed 5 genotypes(type A including A1 and A2 subtypes, type C including C1 and C2 subtypes) by Rep-PCR. We collected 6 different patients' samples of candida albican, among them 3 patients' sample showed the same genotype by itself, another 3 patients' samples showed different genotype by itself.We investigated two genotypes of Candida tropicalis collected from ICU in 2004 and 2005 respectively, one genotype is displayed both in 2004 and in 2005. Strains of Candida tropicalis collected in the same patient and different sample or different date were all showed the same genotype by itself. Perhaps the patient is infected frequently or perhaps only one genotype displayed in the hospital in main.36 strains of candida albican collected in Tangshan City RenMing hospital displayed 2 genotypes by RAPD (Including 5 gene subtypes: 3 of A subtypes and 2 of B subtypes). 8 strains of Candida tropicalis collected in Tangshan City RenMing hospital displayed 6 genotypes by RAPD: one of the genotypes displayed in the first department of chemotherapy, others displayed in the second department of chemotherapy and department of Thoracic Surgery。Conelutions:The most proportion of the fungi collected in Pekin Union Medical College Hospital from 1999 to 2005 is still candida albican, and then Candida tropicalis and Candida glabrata, the proportion of Aspergillus is increased in recent years, the total clinical sample quantity and the positive clinical sample quantity both are increased markedly.Different sample types have different isolates' distributions: In blood sample Candida albicans is the most, others are Candida tropicalis, Candida parapsilosis; Cryptococcus neoformans is the most in cerebrospinal fluid, and then Candida albicans and Candida tropicali; in broncho-alveolar lavage sample Candida albicans is the most, others are Aspergillus fumigatus Penicilliumand Candida glabrata; in urine and vagina, The most is Candida albicans, the second is Candida glabrata and Candida tropicalis. In respiratory tract the most is Candida albicans, the second is Candida tropicalis and Candida glabrata.The main risk factors of candida bloodstream infection are surgical treatment, antibiotic therapy and presence of a central venous catheter.There are clonal strains at ICU PUMCH in 2004 and 2005, candida albican Isolated from the same patient and different sample or different sampling date in 2005 didn't obvioursly show genetic relatedness, and Candida tropicalis displayed gene clonal strains. Candida albican collected in Tangshan City RenMing hospital displayed clearly genetic relatedness, and Candida tropicalis displayed a certain extent genetic relatedness.
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