Tadeusiak B
Zakład Zwalczania Skazeń Biologicznych Państwowy Zakład Higieny, Warszawa.
Rocz Panstw Zakl Hig. 1998;49(1):73-86.
In recent years an increase of the incidence of Candida infections caused mainly by C. albicans strains especially in high risk inpatients with neoplasms, decreased immunity, burns and after treatment with multiple antibiotics has been observed. Candida organisms are particularly dangerous for newborns being responsible for about 30% of septicaemia cases in newborns in intensive care units. Fungal infections can be endogenous in origin but exogenous infection sources occur in hospitals. The cause of the latter are errors in aseptic management and insufficiently disinfected medical instruments and equipment. The purpose of the study was a comparison of the sensitivity to disinfectants of C. albicans belonging to two laboratory strains C. albicans PZH and C. albicans ATCC 10231 used for the determination of concentrations of two disinfectants used. Besides that, this sensitivity was determined in 14 strains isolated from the patients and one from the circuit of dialysis solution supply to artificial kidney. The study was carried out by the qualitative suspension method, in which the cells in the fluid were subjected to the action of disinfectants, and by the carrier method in which the cells of the microorganisms were present on the surface of metal cylinders. By the suspension method the sensitivity was determined to chloramine T in concentrations from 5.0% to 0.001%, formalin from 10.0% to 0.25%, glutaraldehyde from 2.0% to 0.1%, Septyl from 3.5% to 0.25%. The exposure time was 5, 10, 15, 30 and 60 minutes. The tested strains differed in their sensitivity to the disinfectants used. The greatest interstrain differences were observed in the sensitivity to the disinfectants used. The greatest interstrain differences were observed in the sensitivity to chloramine T. The highest concentrations were tolerated by the strains isolated from the patients and from the artificial kidney circuit as well as by the standard strain ATCC 10231. In the 10-minute exposure time accepted by us as comparison standard these strains were 200-time less susceptible to chloramine than the standard C. albicans PZH strain. Two strain isolated from the patients were tenfold as sensitivive. The sensitivity to the remaining tested disinfectants showed less evident differences. The sensitivity of the strains from the patients to formalin was similar to that of the standard PZH strain. A similar sensitivity was found to Septyl, with the exception of the strain from the artificial kidney circuit which was sevenfold less sensitive than the PZH strain. In the case of glutaraldehyde 9 strains from the patients and the ATCC 10231 strain were two or four times less sensitive than the PZH strain. No cross-sensitivity or tolerance to the disinfectants were noted in the study. Both standard strains were similarly sensitive to formalin, but the ATCC 10231 strain was less sensitive to Septyl, glutaraldehyde and chloramine T. In the experiment by the carrier method the effect was evidenced of the surface on the action of disinfectants. This was particularly evident in the case of chloramine T. Even in sensitive strains the disinfection parameters (concentration and exposure time) were significantly higher than in the suspension method. The least sensitive strains survived the effect of 5% chloramine during 2 hours of exposure. Septyl in the working concentration 2.5% at 10-minute exposure time disinfected all carriers with the exception of that carrying the strain isolated from the artificial kidney circuit, which survived 15% Septyl exposure during 10 minutes. The disinfectant Aldesan (2% glutaraldehyde) and formalin 8% killed all fungi during 10 minutes. The study shows that the sensitivity of C. albicans strains to disinfectants varies. For the assessment of the fungicidal action of disinfectants the standard test ATCC 10231 should be used since its sensitivity was similar to that of most strains from the patients and medical equipment. (ABSTRACT TRUNCATED)
近年来,已观察到念珠菌感染发病率有所上升,主要由白色念珠菌菌株引起,尤其是在患有肿瘤、免疫力下降、烧伤以及接受多种抗生素治疗的高危住院患者中。念珠菌对新生儿尤其危险,在重症监护病房的新生儿败血症病例中约占30%。真菌感染可能源于内源性,但医院中也存在外源性感染源。后者的原因是无菌管理失误以及医疗器械和设备消毒不充分。本研究的目的是比较属于两个实验室菌株白色念珠菌PZH和白色念珠菌ATCC 10231的白色念珠菌对消毒剂的敏感性,这两个菌株用于测定两种所用消毒剂的浓度。除此之外,还测定了从患者分离出的14株菌株以及从人工肾透析液供应回路分离出的1株菌株的这种敏感性。该研究通过定性悬浮法进行,其中液体中的细胞受到消毒剂作用,以及通过载体法进行,其中微生物细胞存在于金属圆柱体表面。通过悬浮法测定了对浓度从5.0%至0.001%的氯胺T、从10.0%至0.25%的福尔马林、从2.0%至0.1%的戊二醛、从3.5%至0.25%的Septyl的敏感性。暴露时间为5、10、15、30和60分钟。所测试的菌株对所用消毒剂的敏感性不同。在所观察到的对所用消毒剂的敏感性方面,菌株间差异最大。在对氯胺T的敏感性方面观察到最大的菌株间差异。从患者和人工肾回路分离出的菌株以及标准菌株ATCC 10231能耐受最高浓度。在我们作为比较标准接受的10分钟暴露时间内,这些菌株对氯胺的敏感性比标准白色念珠菌PZH菌株低200倍。从患者分离出的两株菌株敏感性高10倍。对其余测试消毒剂的敏感性差异不太明显。患者菌株对福尔马林的敏感性与标准PZH菌株相似。对Septyl也发现了类似的敏感性,但从人工肾回路分离出的菌株除外,其敏感性比PZH菌株低7倍。对于戊二醛,9株患者菌株和ATCC 10231菌株的敏感性比PZH菌株低2至4倍。研究中未发现对消毒剂的交叉敏感性或耐受性。两个标准菌株对福尔马林的敏感性相似,但ATCC 10231菌株对Septyl、戊二醛和氯胺T的敏感性较低。在通过载体法进行的实验中,证明了表面对消毒剂作用的影响。这在氯胺T的情况下尤为明显。即使在敏感菌株中,消毒参数(浓度和暴露时间)也明显高于悬浮法。最不敏感的菌株在5%氯胺作用2小时后仍存活。工作浓度为2.5%的Septyl在10分钟暴露时间内对所有载体进行了消毒,但携带从人工肾回路分离出的菌株的载体除外,该载体在15%的Septyl暴露10分钟后仍存活。消毒剂Aldesan(2%戊二醛)和8%的福尔马林在10分钟内杀死了所有真菌。该研究表明,白色念珠菌菌株对消毒剂的敏感性各不相同。为评估消毒剂的杀真菌作用,应使用标准测试ATCC 10231,因为其敏感性与大多数患者和医疗设备菌株的敏感性相似。(摘要截选)