临床281例真菌感染的种类分布与耐药性分析

DISTRIBUTION AND DRUG RESISTANCE ANALYSIS OF CLINICALLY 281 STRAINS OF FUN-GUS INFECTION

[目的]探讨临床常见真菌感染的种类及其耐药性特点,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]收集我院2004～2007年住院和门诊患者送检的痰液、尿液、穿刺引流液、分泌物、粪便、血液等标本4153份,用血平板和沙保弱平皿培养、分离、纯化、血清芽管生长试验、法国生物梅里埃API-20CAUX酵母样真菌鉴定板条鉴定,ATB-Fungus板条进行药敏试验。[结果]共分离出281株16种真菌,其中主要为白假丝酵母菌164株,占58.4%,热带假丝酵母菌47株,占6.7%,毛霉菌13株,占4.6%。分离的菌株对两性霉素B(AMB)和5-氟胞嘧啶(5-FC)的敏感率很高,而对伊曲康唑(ITR)和氟康唑(FCA)的耐药性率较高。[结论]真菌感染以白假丝酵母菌为主,两性霉素B(AMB)和5-氟胞嘧啶(5-FC)具有较强抗真菌活性,临床医生应重视实验室真菌培养以及鉴定结果,合理使用抗真菌药物。

[ Objective] To explore the normal kinds of yeast-like fungi causing hospital infection and characteristics of drug resistance, so as to provide guideline of etiologic diagnosis and suitable anti-fungus management for clinic infective diseases. [Methods] 4153 samples of plate culture, urine, drainage liquid by puncturation, secretion, feces and blood were collected from the out-patients and inpatients from 2004 to 2007. The fungi were cultured with general method of blood culture medium, separated, turned purety, bud tube grew to experiment in serum, isolated and indentified with API-20CAUX indentification system. The antifungal sensitivity was detected with ATB-Fungus trip. [Results] A total of 16 species were identified from 281 strains of fungus, predominantly strain were 164 strains of Candida abicans （ 58.4% ） , 47 strains of C.tropicialis （6.7%）, and 13 strains of Mucor （4.6%）. Theisolated fungi were relatively sensitive to amphotericin B, and fluconazole, but the drug resistance to itraconazole and 5-flucytosine ishigher. [Conclusion] C.albicans is the essential strain in fungus infection. AMB and 5-FC are effective way in therapy of fungus infection. Isolation and anti-fungal sensitivity tests should be stressed for clinical selection of reasonable anti-fugals.