| Objective:To provide an insight into the prevention and cure of fungal infection for elderly inpatients, we investigated the colonization rate, species distribution, risk factors, and the drug sensitivity of oral fungi in the elderly.Methods:248 elderly inpatients in Department of Cadre Medicine and 826 healthy subjects in medical center, the First Affiliated Hospital of Kunming Medical University, were recruited. The oral samples were collected using the mucosal swab method. Then the Candida species were isolated by the CHROMagar Candida (CA), and identified by the API 20C AUX yeast identification system. Meanwhile, we performed a antifungal drug sensitivity test using broth micro dilution method in order to analyze their drug resistances.Results:In the group of elderly hospitalized patients, two kinds of fungal species were isolated from a total of 111 strains. Of these two species, Candida albicansswas dominant (95.5%). The only non-albicans Candida species detected was C. glabrata, (4.5%). In the group of healthy subjects, seven kinds of fungal species were isolated from a total of 163 strains. C.albicansrwas the most abundant species (73.01%) Of thenon-albicans Candida species,C.parapsilosis accounted for 12.88%,smooth Candida 9.20%,C.krusei 1.84%, C.tropicalis 1.84%, C.lustitaniae 0.61%, and C.guilliermondii 0.61%.Further study indicated that denture wearing, the number of antibiotics usage days and diabetes history were significantly correlated to the oral fungal colonization in elderly inpatients(p<0.05), while gender, age, tumor history, smoking history, respiratory infections, hormone usage, antibiotics usage had no significant correlation with oral fungal colonizationin elderly hospitalized patients (p> 0.05).For oral colonized fungi, the vitro antifungal drug sensitivity test in the groupof elderly inpatients showed that the MIC ranges of fluconazole, itraconazole, AmphotericinB and voriconazole were 0.125-64μg/ml,0.5-8μg/ml,0.063-4μg/ml and 0.125-1μg/ml, respectively, whereas those in the group of healthy subjects were 0.125-64μg/ml,0.031-16μg/ml,0.25-2μg/ml and 0.031-16μg/ml, respectively. In the group of elderly inpatients, the strains of C.albicans had the highest resistance rate to itraconazole(90.09%), and amphotericin B (42.34%). In contrast, they were comparatively sensitive to fluconazole and voriconazole, their resistance is 1.8% and 0.9% respectively. However, in the group of healthy subjects the strains of C. albicans had a higher resistance rate to amphotericin B(13.5%), itraconazole (12.88%). They were sensitive to fluconazole and voriconazole (both 2.45%). Among thenon-albicans Candida species, C.glabrata in the group of elderly inpatients had a high resistance rate to amphotericin B (20%), and was sensitive to azole antifungals. In the group of healthy subjects, both C.glabrata and C.krusei had a relatively high resistance to azole antifungals. The drug resistance rates to itraconazole and amphotericin B in the group of inpatiens were higher than those in the group of healthy subjects (p<0.05). While the drug resistance rates to fluconazole and voriconazole had no significant differences (p>0.05) in both groups.Conclusion:The oral fungal colonization rate in elderly inpatients is significantly higher than it in healthy people. C.albicans is the most common fungus in both groups of people. Among thenon-albicans Candida species, C.glabrata, which has strong pathogenicity, is common in elderly inpatients, while C.parapsilosis, which is characterised by transient colonization and doesn’t have obvious pathogenicity, is dominant in healthy people. Denture wearing, the number of antibiotics usage days and diabete shistory are the high risk factors of oral fungal colonization in elderly inpatients. The fungi in the group of elderly inpatients are sensitive to fluconazole and voriconazole, This study provides an insight into the prevention and cure of fungal infections in the elderly population. |
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