Pathogenic Bacteria And Drug Sensitivity Detection And Genotype Study Of Vulvovaginal Candidiasis

Objective: This study by collecting conforms to the demands of group of vulva vagina candidiasis(VVC)of clinical cases,to explore the distribution characteristics of VVC pathogenic bacteria in our country.The sensitivity of pathogenic bacteria to antifungal drugs was detected to provide clues for clinical rational drug use.To understand the genotype distribution of pathogenic bacteria and preliminarily discuss the occurrence of disease and the relationship between drug resistance and genotype.Method: Vaginal secretions of VVC patients to be determined clinically were collected,and the collected samples were identified by means of bud tube thick-wall spore test,chromagar medium,mass spectrometry(maldi-tof,MS)and molecular biology.At the same time,relevant information of patients in the questionnaire was collected,and relevant clinical data of VVC patients were statistically analyzed.With reference to The United States national Institute of standardization of Clinical and Laboratory(CLSI)recommended M27-A3,The requirements of The relevant drug sensitivity test method using yeast trace dilution test strains collected to fluconazole,itraconazole,voriconazole and posaconazole,nystatin and amphotericin B,mooring Finn net card and than naphthalene Finn,etc.8 kinds of drug sensitivity in vitro.Microsatellite genotyping technology was used to genotype the strains identified as candida albicans.Fluorescence labeled primers were used for amplification,and the purified products were scanned by capillary electrophoresis.Genescan software was used to analyze the fragment size to determine the genotype of candida albicans.Result: 1? A total of 649 clinical samples eligible for enrollment were collected from Sichuan provincial people's hospital and Nanjing dermatology hospital of Chinese academy of medical sciences from 2016 to 2018.There were 368 cases of pure VVC,accounting for 56.7% of the total samples.There were 299 cases of complex VVC,accounting for 46.1% of the total samples,including 81 cases of RVVC,131 cases of SVVC,68 cases of pregnancy VVC,3 cases of non-candida infection,and 15 cases of other combined diabetes and immunosuppressive agents.2?In 649 clinical samples,the number of Candida albicans was 576,accounting for 88.75%.The total number of non-Candida albicans was 73,of which the number of Candida glabrata was 57,the number of Candida krusei was 9,the number of Candida albicans was 4,and the other were non-Candida.3?The sensitivity rate of 576 strains of Candida albicans to caspofungin was 99%,and the sensitivity of voriconazole was 81.8%.The resistance rate of fluconazole was the highest,and 41 strains of Candida were resistant to fluconazole,and the drug resistance rate reached 7.1%.According to the epidemiological breakpoint(ECV),the number of not-wild type of Itraconazole was the highest;the posaconazole was the second.Candida albicans show the highest sensitivity to amphotericin B.4?57strains of Candida glabrata were the most sensitive to posaconazole and amphotericin B.Candida krusei has the highest sensitivity to amphotericin B;it has the lowest sensitivity to fluconazole and itraconazole.Candida parapsilosis showed high sensitivity to all six drugs.5?A total of 53 genotypes were obtained from 576 strains of Candida albicans,among which 30-45 genotype strains were the most abundant,and the genotypes of C.albicans were mainly 30-45,31-45 and 32-45,accounting for three genotypes.The sum of the ratios reached 55.56%,which was more than half of the total number of samples,showing a clear advantage distribution.The proportion of simple VVC in the three genotypes of 16-16,17-17 and 22-22 was close to 100%,and the difference was statistically significant,which may be the dominant genotype of VVC alone.The genotypes of complex VVC are mainly distributed in 30-45,32-45,31-45 and 32-45.6?The fluconazole-resistant strains were more genotypes with higher numbers of repeats at 30-45,32-45,32-48,30-47,32-46,and 34-45.The genotypes of voriconazoleresistant strains are mainly 38-46,30-46,30-47.The genotypes of the strains with higher MIC values of itraconazole are mainly 30-45,30-47,30-46.Conclusion: 1?Candida albicans is the main pathogen of vulvovaginal candidiasis,but the proportion of non-Candida infection is also increasing.The number of patients with complex VVC has increased and should be taken seriously.The risk factors for complex VVC are pregnancy and diabetes,sexual life,and susceptible populations at the age of 25 to 45,with a high incidence.2?The same strain of Candida albicans can produce cross-resistance to a variety of drugs.For the treatment of VVC caused by Candida albicans,azole drugs can be selected as an empirical treatment;fluconazole resistance rate is high,so RVVC is not recommended.Terbinafine is not effective in treating VVC.The use of azoles for the treatment of VVC caused by non-Candida albicans is not recommended,and amphotericin B or nystatin substitution can be selected.3?The genotype of Candida albicans is mainly distributed in the range of 30~32-45,and the pathogen of the Candida albicans strain of VVC is more homozygous.The genotypes of the complex VVC genotypes and drug-resistant strains are more likely to be distributed in genotypes with higher numbers of repeats.