医院内深部真菌感染的前瞻性调查

Nosocomial Fungal Infections in Target Population:A Prospective Survey

目的 了解目标人群医院内真菌感染的危险因素、发病率和疾病谱。方法 对 1997年 10月～ 1999年 12月间在我院部分病房住院治疗的患者的医院内真菌感染进行前瞻性调查、分析 ,对分离到的其中 5 6株白色念珠菌进行药敏试验。结果 医院感染和医院内真菌感染的发病率分别为 12 .3%和 2 .5 7% ,医院内真菌感染的主要部位分别是口腔 ( 39.5 1% )、下呼吸道 ( 34.5 7% )和尿路 ( 17.2 8% ) ,主要的真菌为念珠菌 ( 90 .6 2 % ) ;医院内真菌感染的发生与免疫抑制剂治疗、多种广谱抗生素的使用 ( >3种 )、气管切开或插管、昏迷 ( >3d)、年龄≥ 6 5岁、留置导尿、恶性肿瘤性疾病等有关 ;白色念珠菌对两性霉素 B、氟康唑、氟胞嘧啶和伊曲康唑的敏感性分别为 10 0 %、94 .6 %、92 .86 %和 5 7.1%。结论 接受免疫抑制剂和多种广谱抗生素治疗、昏迷、体内留置导管的患者易发生医院内真菌感染 ;白色念珠菌仍是医院内真菌感染的主要病原 ;药敏试验表明 ,白色念珠菌对两性霉素 B、氟康唑、5 - FC高度敏感 。

OBJECTIVE To investigate the risk factors, incidence and disease spectrum of nosocomial fungal infections. METHODS A prospective survey of nosocomial fungal infections was conducted on target patients hospitalized between Oct 1997-Dec 1999. Fifty six strains of Candida albicans isolated from patients with invasive fungal infections were tested for susceptibility to common antifungal agents. RESULTS The rates of nosocomial infections and nosocomial fungal infections were 12.30% and 2.57%, respectively. Nosocomial fungal infections occurred mainly in oral cavity (39.51%), lower respiratory tract (34.57%) and urinary tract (17.28%), the main pathogens of nosocomial fungal infections were Candida spp (90.62%). Developments of nosocomial fungal infections were closely associated with immunosuppressive therapy, endotracheal intubation or tracheotomy, coma (lasting more than 3 days), infusion of broad-spectrum antimicrobial agents (≥3 types of antimicrobial agents used simultaneously), malignancy and old age (≥65 years old). The rate of C. albicans susceptibility to amphotericin B, fluconazole, flucytosine (5-FC) and itraconazole were 100%, 94.6%, 92.86% and 57.1%, respectively. CONCLUSIONS The rate of nosocomial infections was higher in patients with immunosuppression, coma, indwelling catheters or receiving broad-spectrum antimicrobial agents therapy. Candida spp are still the main pathogens of nosocomial fungal infections. C. albicans has a high degree of susceptibility to amphotericin B, fluconazole and 5-FC and a lower degree of susceptibility to itraconazole.