冠心病监护病房院内深部真菌感染临床分布及耐药分析

Clinical distribution and drug resistance of deep fungal infection in coronary heart disease care unit

目的分析我院冠心病监护病房(CCU)患者院内深部真菌感染的危险因素及耐药性,并探讨对策,以达到控制院内真菌感染的目的。方法采用回顾性调查方法,对我院CCU2002年1月至2005年1月收治的177例患者逐一调查。结果CCU患者深部真菌感染发生率为21·5%;感染部位以下呼吸道最多,其次为肠道、尿道及血液;基础疾病以心源性休克、急性左心衰、心脏骤停复苏后患者感染例次最高。分离的42株真菌中以白色念珠菌最多,其次为热带念珠菌;药敏结果发现酮康唑和益康唑耐药性较高。结论应加强对CCU内老年患者及心源性休克、心脏骤停复苏后等医院真菌感染高危疾病的监控,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,以减少患者并发症,控制医疗成本。

Objective To analyze the risk factors and drug resistance of deep fungal infection in coronary heart disease care unit （ CCU）, and to explore the strategy to control this disease. Methods A retrospective analysis was carfled out among 177 patients who were admitted to our CCU from January 2002 to January 2005. Results The percentage of deep fungal infection in CCU-cared patients was 21.5%. The most common infection site was lower respiratory tract, followed by intestine,urethra and blood. The underlying diseases and conditions were usually cardiogenic shock, acute heart failure, cardiopulmonary resuscitation （CPR） after cardiac arrest. C. albicans was the most common species, followed by candida tropicalis. Ketoconazole （KTC） and econazole （ECO） had higher tolerance. Conclusions We should intensify the inspection of the patients, who have cardiogenic shock, CPR after cardiac arrest in CCU. Therefore, physicians should initially carry out bacterial culture and antimicrobial susceptibility test so as to select appropriate antimicrobial or antifungal agents, so that the complications and medical cost of patients can be effectively controlled.