医院内深部真菌感染的临床分布和药敏结果

Nosocomial Deep Fungal Infections:Clinical Distribution and Antimicrobial Susceptibility Profile for 350 Strains

目的对350株临床深部真菌感染的标本进行分离鉴定和药敏试验,了解患者真菌性医院感染现状,为临床感染性疾病提供病原学诊断和合理使用抗真菌药物的依据。方法按常规方法培养,采用念珠菌显色培养基进行鉴定,对于少见的念珠菌采用PCR技术鉴定;对真菌用棉蓝染色直接镜检和培养相结合的方法进行鉴定。采用纸片扩散法进行药敏试验。结果350株真菌标本中,念珠菌属329株,占94.00%;真菌(丝状菌)21株,占6.00%;分离菌株对药物的敏感性分别为氟康唑92.40%、两性霉素B 97.57%、伊曲康唑93.01%、5-氟胞嘧啶88.10%。结论院内真菌感染以念珠菌属最为多见,特别是白色念珠菌和热带念珠菌;药敏结果显示氟康唑、两性霉素B、伊曲康唑、氟胞嘧啶均有较高的抗菌活性,但氟康唑对克柔念珠菌和光滑念珠菌有较高的耐药性;对送检标本及时进行真菌培养和药敏实验,合理使用抗真菌药物,减少多重耐药和深部真菌感染的发生。

OBJECTIVE To investigate the current status about deep fungal infections in hospital and to provide the evidence to clinical treatment by identification and susceptibility test for 350 strains of fungal infections in target population. METHODS Totally 350 fungi strains were cultured according to the routine method and isolated with CHRO-Megar medium. Some rare strains were identified by PCR technology. The strains were dyed with cotton blue to directly examine under microscope and combined with being cultured by Sabouraud medium. The susceptibility test was determined by Kirby-Bauer methods. RESULTS Among the 350 fungi strains, 329 were Candida spp which accounted for 94. 0%, the rest 21 were mould strains which accounted for 6%. The susceptibility rate to fluconazole, amphotericin B, itraconazole, and flucytosine was 92.4 %, 97.57 %, 93.01 %, and 88.1%, respectively. The distribution of fungi was higher in ICU（22.9%） than in other wards. CONCLUSIONS Candida spp infections are most common among nosocomial fungal infections, especially Candida albicans and C. tropicalis. The results of susceptibility test show that the fungi are good susceptible to fluconazole,amphotericin B, itraconazole and flucytosine. But fluconazole for C. k rusei and C. glabrata is highly resistant. Therefore, the clinic should choose the appropriate antifungal agents and minimize the incidents of multiresistance of deep fungal infections according to the culture and in vitro susceptibility of fungi.