医院分离深部真菌菌株流行病学调查和药敏试验研究

Epidemiological study on pathogens of deep fungal infection

目的了解广东地区医院近年深部真菌感染的动态变化,为临床经验性治疗提供依据。方法回顾分析了1998—2004年我科真菌室接受的疑诊为深部真菌感染的标本9574份,分离出阳性标本3122份(阳性率32.6%),共13个菌种。药敏试验采用浓度梯度法。结果真菌学变化:白念珠菌近3年所占构成比:白念珠菌在2002—2004年组所占构成比与1998—2001年组相比显著下降(76.3%、66.8%比较,x^2=34.33,P<0.05);光滑念珠菌、近平滑念珠菌构成比显著增加(4.2%、11.1%比较,x^2=51.30,P<0.05,2.2%、4.0%比较,x^2=8.82,P<0.05);马内菲青霉菌近年呈现增多趋势。药敏试验:2000—2004年703株真菌菌株药敏试验结果显示,对伊曲康唑、氟康唑、酮康唑、两性霉素的耐药株均无增加趋势,伊曲康唑敏感株显著减少(71.0%、58.2%比较,x^2=16.50,P<0.05),中介株显著增多(7.8%、24.8%比较,x^2=24.8,P<0.05),其中以白念珠菌、热带念珠菌对伊曲康唑敏感株减少为主。结论白念珠菌近年所占构成比显著下降;光滑念珠菌、近平滑念珠菌构成比显著增加;出现了新的感染菌株马内菲青霉菌。白念珠菌、热带念珠菌对伊曲康唑敏感株显著减少。此种真菌菌学变迁及药敏试验的变化应引起临床医师重视。

Objective To investigate the dynamic distribution changes of fungi responsible for the deep infection and antifungal susceptibility to provide a basis for the empirical antifungal treatment. Methods Medical records were reviewed from cases suspoctedof deep fungal infection at our hospital from January 1998 to December 2004. 3122 isolates of 13 species were analyzed with SPSS11.0. Etest was used for the antifungal susceptibility test. Results Candida albicans was the most commonly isolated organism, while the prevalence of Candida albicans decreased（76. 3% vs 66. 8% ,X2 = 34. 33 ,P 〈 0. 05 ） during the second haft of this study （2002-2004）, with the increasing incidence of Candida glabrata and Candida parapsilosis （4.2% vs 11.1%,X^2 =51.30,P 〈0.05, 2.2% vs 4.0%,X^2 =8.82, P〈0. 05）. Penicillum marneffei increased concurrently. During the 2000-2004 year study, the isolates resistant to amphotericin B, itroconasole, ketoconasole, and fluconasole were showed no increase, while the strains of C. albicans and C. tropicalis susceptible to itroconazole decreased （ 76. 8% vs 66. 1% ,X^2 = 6. 87, P 〈 0. 05; 74. 5% vs 57.9% ,X^2 = 20.91,P 〈0.05） ,with the intermediately susceptible strains increasing（8. 1% vs 23. 1%, X^2 =12.63,P〈0.05; 17.6% vs 36.8% ,X^2 =4.78,P〈0.05）. Conclusion The prevalence of Candida a[bicans decreased with Candida glabrata and Candida parapsilosis increasing, Penicillium marneffei increased concurrently. The strains of C. alhicans and C. tropicalis susceptible to itroconasole decreased with the intermediately susceptible strains increasing.