临床真菌检测及耐药性动态变化特征及分析

Detection of clinical deep fungal infection and analysis of its drug resistance features

目的了解临床标本真菌检出情况,并进行真菌耐药性分析,为临床合理使用抗真菌药物提供依据。方法常规培养分离真菌,用科玛嘉产色培养基和Vitek全自动微生物分析仪鉴定到种。药敏试验采用ATBFungus3微量最低抑菌浓度药敏试验试剂盒。结果共检出476株深部真菌,2006、2007、2008年检出率分别为10.04、14.53、18.08,呈逐年增加的趋势;菌种以白色念珠菌(64.50)、热带念珠菌(15.97)、光滑念珠菌(11.76)为主。真菌检出科室以干部病房(36.76)、重症监护室(14.08)为主;感染标本来源以呼吸道和泌尿道为主,分别占63.24和8.40;真菌对氟胞嘧啶、氟康唑、伊曲康唑、两性霉素B、伏立康唑的耐药率分别为5.7、9.9、32.4、2.3、1.3。结论深部真菌感染逐年增多,对两性霉素B和伏立康唑最为敏感。伊曲康唑、氟康唑耐药率较高,临床用药应根据药敏结果合理选用。

Objective To detect clinical deep fungal infection and analyze its drug resistance. Methods Fungi were cultured and isolated by routine procedure, which were identified by CHROMagar Candida color medium and VITEK microbe antomatic system. Drug susceptibility test was processed by ArFB Fungus3. Results 476 deep fungi strains in all were isolated from 2006 to 2008. The detection ratio in each year was 10. 04% ,14.53% and 18.08% ,which increased year by year. The mainly isolated fungi were C. albicans （64.50%） ,C. tropicals （15.97%） ,and C. torulopsis glabrata （11. 76%）. The fungi strains were mainly found in the wards of geriatric department （36.76%） and ICU （14.08 %）. The mainly infection specimens were from respiratory tract and urinary tract with 63.24 % and 8.40 % respectively. Drug resistance rates to flucytosine, fluconazole, itraconazol,amphotericin B and vorieonazole with ATB Fungus3 were 5. 7 %, 9. 9 %,32. 4 %, 2. 3 % and 1. 3 %, respectively. Conclusion There was a growing trend of deep fungal infection. Fungus was the most susceptible to amphotericin B and voriconazole. Itraconazol and fluconazole had higher drug resistance rates to all fungus. It should be better to consult the results of fungus drug sensitivity test when using drugs in clinical.