Study On The Spectrum And Drug Resistance Of Oral Candida In HIV/AIDS And ICU Patients

Objective 1.Through the first examination and continuous monitoring of oral candida infection and colonization in ICU patients,as well as clinical data analysis,to understand the current situation of oral candida infection,pathogen changes,and drug resistance in ICU of general hospitals,and to provide new basis for the prevention and treatment of fungal infections in critically ill patients of general hospitals,and to provide reference for the detection of pathogen resistance in candida infection in general hospitals;2.Understand the oral candidiasis spectrum of ICU patients and HIV/AIDS patients through molecular biological identification,and analyze the risk factors related to oral candidiasis infection in ICU patients.Methods 1.Collect clinical data of hospitalized patients and HIV/AIDS patients in our hospital’s ICU from July 2021 to March 2023,and conduct microscopic examination,culture,and molecular biological identification of fungi in patients’ oral secretions;Based on clinical data,the epidemiological characteristics of oral candidiasis in two types of patients were analyzed.Chi-square test and single factor logistic regression were used to analyze the risk factors for oral candidiasis;3.According to the M27-A3 protocol proposed by the Association for Clinical and Laboratory Standards(CLSI),the in vitro drug sensitivity test was conducted using the micro multiple dilution method.Results The first part: 1.Observing 97 patients in ICU,it was found that 53 patients(infection group)were infected with oral candidiasis,accounting for 54.6%,and 44patients(carrier group),accounting for 45.4%;2.A total of 193 strains of Candida were isolated,including 124 strains of Candida albicans,35 strains of Candida glabra,11 strains of Candida tropicalis,8 strains of Candida krusei,13 strains of Candida nearly smooth,1 strain of Corynespora portuguese,and 1 strain of Diutina rugosa(heterotrophic nitrification aerobic denitrification folded Candida);3.The analysis of risk factors of oral candidiasis infection in ICU patients showed that wearing false teeth,combined use of antibiotics,invasive medical measures,multiple organ failure,diabetes,upper gastrointestinal diseases,major infectious diseases,and length of hospital stay were the risk factors of oral candidiasis infection in ICU patients,and the use of glucocorticoids,immunosuppressants,tumor patients,age and other related risk factors were not statistically significant;4.The results of continuous and multiple monitoring of 24 patients showed that during the course of diagnosis and treatment,oral candidiasis infection and/or colonization of 7 patients would change,mainly due to the gradual transformation of Candida albicans into smooth Candida,and during the monitoring process,the MIC value of the same strains isolated from the same patient against some anti fungal drugs gradually increased;5.There was a statistically significant difference in the MIC values of fluconazole,voriconazole,and caspofungin among the Candida isolates from the infection group and the carrier group(P<0.05),and the MIC values of the infection group were higher than those of the carrier group;6.A strain of Candida glabrata was found to be resistant to amphotericin B and was re sensitive to amphotericin B after three passages.The second part: A total of 160 oral samples from HIV/AIDS patients were collected,of which 16 were infected with oral candidiasis,accounting for 10%,and32 were carriers,accounting for 20%.The remaining 112 patients had no Candida detected in their oral samples;A total of 48 strains of Candida were isolated,including35 strains of Candida albicans,8 strains of Candida tropicalis,2 strains of Candida smoothii,1 strain of Candida krusei,1 strain of Candida nearly smoothie,and 1 strain of Saccharomyces cerevisiae;3.Univariate ANOVA and nonparametric test statistical analysis of laboratory test results of HIV/AIDS patients showed that CD4+and CD4+/CD8+had no statistical significance between oral candidiasis infection and carrier,but had statistical significance between infection and negative,and between carrier and negative.There was no significant difference in the overall sample of CD8+;4.High efficiency retroviral therapy for HIV/AIDS patients has statistical significance with oral candidiasis infection and carrier;5.There was no significant difference in the MIC of fluconazole,voriconazole,caspofungin,and amphotericin B between the HIV/AIDS infection group and the carrier group(P>0.05).Conclusion 1.The incidence of oral candidiasis in ICU patients is extremely high(nearly 60%),which requires high attention and timely prevention and treatment;2.The risk factors of oral candidiasis infection in ICU patients are somewhat different from those in other departments of the general hospital.The false teeth,combined use of antibiotics,invasive medical measures and length of hospitalization are the same as those in other departments,but the use of glucocorticoids,immunosuppressants,tumors and advanced age and other factors have no significant impact on whether oral candidiasis infection occurs in ICU patients,while multiple organ failure,diabetes,severe gastrointestinal diseases Sepsis is an independent factor of oral candidiasis infection in ICU patients,and vigilance should be enhanced for such patients;3.The drug sensitivity test found that amphotericin B resistant strains appeared,and the MIC value of Candida to commonly used antifungal drugs increased during infection,which reminded clinical attention to the rational use of antifungal drugs;4.It is suggested that high efficiency retroviral therapy can reduce the incidence and colonization rate of oral candidiasis in HIV/AIDS patients;5.CD4+and CD4+/CD8+are suggestive of Candida infection and colonization in HIV/AIDS patients.