270例深部真菌感染患者的病原学检测和耐药性分析

Pathogenic detection and drug-resistance analysis of 270 patients with deep fungal infection

目的 探讨儿童深部真菌感染情况,分析其对常用抗真菌药物的敏感性,为真菌感染的治疗和预防提供依据。方法 回顾性分析了2009年3月～2012年12月延安大学附属医院270例确诊为深部真菌感染住院患儿的临床资料,药敏试验严格按照2006年CLSI M272A2规则及标准进行AmB、FCZ,5-FC、ICZ 4种抗真菌药敏检测。结果 真菌感染样本主要来源于咽拭子,白假丝酵母的分离率最高61.11%,其次为光滑假丝酵母菌、热带假丝酵母菌、近平滑假丝酵母菌和克柔假丝酵母菌。药敏实验结果表明,假丝酵母菌对AmB、5-FC的敏感性较高。儿科患者中分离的真菌中以假丝酵母菌属最多,并以白假丝酵母菌为主。AmB、5-FC均有较高的抗真菌活性。结论 应加强对临床真菌感染与耐药性情况的监测,以指导临床合理使用抗生素。

Objective To investigate the distribution and drug resistance of deep fungal infection in children and provide a basis for the treatment and prevention of fungal infection. Methods The data of 270 cases with deep fungal infection were retrospectively analyzed from March 2009 to December 2012 in a hospital of Yan’an City .The susceptibility to AmB, FCZ, 5-FC, ICZ were analyzed according to the guidelines of CLSI （Clinical and Laboratory Standard Institute） M272A2. Results The specimens were collected from nasopharyngeal swabs. The isolation rate of Candida albicans was the highest （61.11%） ,followed by Candida glabrata,Candida tropicalis,Candida parapsilosis and Candida krusei. The results of drug sensitive test showed that the sensitivities of Candida to amphotericin B and 5-fluorouracil were high.Candida strains, especially Candida albicans , were most common species in children with fungal infection. 5-fluorocytosine and amphotericin B were effective on deep fungal infection. Conclusion Monitoring of clinical fungus infection and its drug-resistance be enhanced in order to guide the reasonable clinical use of antibiotics .