深部真菌感染的临床分析及耐药性监测

Clinical Analysis on Deep Fungal Infection and its Drug-resistance Surveillance

目的探讨深部真菌感染,分析病原菌与病因,监测耐药情况。方法采集近4年患者感染的深部标本进行真菌培养,用API板条鉴定,用E-test纸条做药敏试验并对临床资料进行分析。结果共检出1310株深部真菌,2004-2007年检出构成比分别为9.8%、17.6%、34.0%、38.5%,呈逐年增加趋势;菌种以白念珠菌(67.9%)、近平滑念珠菌(11.0%)、热带念珠菌(9.8%)为主;科室以ICU(28.2%)、呼吸内科(17.9%)、老年病科(15.8%)为主。深部真菌感染的危险因素有连续使用2～9种抗生素7d或7d以上,有严重基础病或致死性疾病,年龄>65或<1岁,癌症放疗化疗后,留置各种导管等五种主要因素较常见。整体耐药率两性霉素(0.7%)最低,氟康唑(22.1%)最高。近两年与前两年相比,氟康唑的耐药性有增加趋势(19.5%和23.1%,χ2=1.88,P>0.05),伊曲康唑耐药性则明显增加(9.2%和16.4%,χ2=6.21,P<0.05);热带念珠菌对氟康唑的中介度也明显增加(9.1%和20.5%,χ2=5.23,P<0.05)。结论真菌感染逐年增多,耐药性增高,因此真菌感染病原菌的病因分析及其耐药性监测对指导临床合理使用抗生素十分重要。

Objective To investigate the pathogens and causes in deep fungal infection, and to analyze its drug - resistance. Methods The samples from the depth infection patients in the resent 4 years were collected to cultivate fungus and identified by API. E - test was used for the antifungal susceptibility test. Clinical data were analyzed at the same time. Resuits Totally 1,310 deep fungi strains were isolated during the period of 2004-2007. The detection ratio in each year was 9.8%, 17.6%, 34.0% and 38.5%, and increased year by year. The mainly isolated fungi strains were C. albicans （67.9%）, C. parapsilosis （11.0%）, and C. tropicals （9.8%）. The fungi strains were mainly found in the wards of ICU （28.2 % ）, respiratory department （17.9 % ）, and geriatric department （15.8 % ）. The risk factors of deep fungal infection were the usage of 2-9 kinds of broad- spectrum antibiotics for or more than 7 days, critical basin - disease or deadly disease, at the age of above 65 or less 1 - year, cancer undergoing chemotherapy or radiotherapy, save cannulas, etc. The most effective drug was amphotericin B （0.7 % ）, and the drug resistance of fluconazole was the strongest （22.1% ）. Compared the resent 2 years with before 2 years, there was an increasing trend of fungus resistance on fluconazole, but the resistance of itroconazole（9.2 % and 16.4 %, x^2 = 6.21, P〈 0.05 ） and the C. tropicals＇ mid - resistance to fluconazole（9.1% and 20.5 % ,x^2 = 5.23, P〈 0.05） were increased. Conclusions There is a growing trend of invasive fungus infection, and drug resistance is serious. Therefore analyzing the pathogen of deep fungal infection and monitoring drug resistance are very important for instructing clinical doctors to use antibiotics properly.