侵袭性真菌医院内感染的流行病学调查

Epidemiologic study on patients with invasive fungal infections

目的探讨住院患者侵袭性真菌感染（IFI）的流行病学特点。方法血培养使用BacT ALERT 3D血培养检测仪，其他各种临床标本用沙堡氏培养基培养，科玛嘉显色培养基分离鉴定念珠菌。对2004年1月1日至2007年12月31Et间的2891例真菌感染患者的临床病历进行总结，从患者年龄、性别、疾病种类、标本、菌种分布、科室等方面进行分析。结果住院患者IFI的发病率为4．12％，患者年龄7～96岁，以男性老年患者为多，均有基础疾病；感染部位以下呼吸道为最多；检出的真菌种类以念珠菌属为主，其中自念珠菌占67．29％，霉菌占6．20％。4年间细菌、真菌检出率及真菌检出率占细菌和真菌检出率的构成比、标本来源、菌种以及科室分布的构成比、抗真菌药物和抗细菌药物的使用率均有所不同，采用Z检验和Bonferroni法进行多重比较，差异有统计学意义（P〈0．0083）。结论住院患者真菌感染的标本来源、菌种和科室分布的构成比在不断发生改变，IFI的流行病学特征发生改变。念珠菌仍是主要的致病真菌，但各种念珠菌的菌种构成比有所变化，曲霉菌属引起的感染有增多趋势。

Objective To investigate the epidemiological features of patients with nosocomial invasive fungal infection. Methods Ftmgi in blood were identified by BacT ALERT 3D, other clinical samples were cultured by Sabouraud＇ s dextrose agar （SDA） medium. Candidas were isolated and identified by CHRO Magar candida color medium. Fungus-cultured positive cases from Jan. 2004 to Nov. 2007 were analyzed on items as patients＇ age, underlying disease, sample, strain, and species distribution. All statistical analyses were carried out by SPSS 13.0. Results The overall incidence rate of invasive fungal infections was 4.12%. The average age of patients was 7-96 with most patients were male, with geriatric problems and different kinds of underlying diseases. Lower respiratory tract infection was the most frequent infection site, followed by urinary tract, gastrointestinal tract. The main pathogens of invasive fungal infections were Candidas （93.80%）. Strains of Candida albicans were the most frequent organisms which accounted for 67.29% of all the isolates. Mould fungus infections accounted for only 6.20%. During the 4 years of observation, the detection rate of fungi, specimen sources and the distribution of species and compartment were different with significant differences （P〈0.0083）. Conclusion The epidemiological properties such as the source of specimen, the distribution of species and composition sections of invasive fimgal infections were changing. Candida spp. were still the main pathogens of invasive fimgal infections but the sections of fungi changed. The incidence of Aspergillus infections had been increasing recently.