广谱抗生素对肠道菌群紊乱诱导的侵袭性真菌感染的影响

Effect of broad-spectrum antibiotics on invasive fungal infection induced by intestinal flora disturbance

目的探讨广谱抗生素对肠道菌群紊乱诱导的侵袭性真菌感染(IFI)的影响。方法回顾性收集ICU院内获得性感染92例,根据细菌检测结果分别采用二代头孢菌素、酶抑制剂、碳青霉烯类抗生素治疗,于抗生素治疗前和治疗后3、7天进行细菌学检测,治疗前和治疗后3、7天和14天行大便球杆菌比例和念珠菌的检测。结果应用广谱抗生素治疗后患者肠道球杆菌比例增高,并随应用时间的延长,球杆菌比例呈进行性升高,治疗后7天与治疗后3天比较有显著性差异(P<0.001);并在粪便内检出白色念珠菌、光滑念珠菌、热带念珠菌等。酶抑制剂和碳青霉烯组在治疗7天后即可出现IFI,14天后IFI发生率增加,且维持原方案治疗者肠道菌群紊乱加重(P<0.001),真菌感染发生率高于降阶梯治疗者。结论广谱抗生素的应用造成肠道菌群紊乱,IFI发生率增高,需合理调整抗生素方案以控制IFI的发生率。

Objective To study the effect of broad-spectrum antibiotics on invasive fungal infection induced by intestinal flora disturbance.Methods Ninety-two patients with nosocomial infection were collected and retrospectively analyzed.Second generation cephalosporin,enzyme inhibitor and carbapenem were respectively used according to the bacteria test results of patients.These bacteria tests were conducted before bacteria treatment and on the 3rd day,7th day after the treatment.Fecal coccus-bacillus ratio and candida test were conducted before and on the 3rd day,7th day and 14th day after the treatment.Results Intestinal coccus-bacillus ratio increased with the application of broad-spectrum antibiotics.Candida albicans,candida glabrata and candida tropicalis were detected in the feces of patients.Invasive fungal infection occurred on the 7th day in enzyme inhibitor and carbapenem groups,and increased on the 14th day.Intestinal flora disturbance became worse and the incidence of invasive fungal infection notably increased in groups which maintained original therapeutic regimen.Conclusion Broad-spectrum antibiotics treatment caused intestinal flora disturbance and increased incidence of invasive fungal infection.Therapeutic regimen of antibiotics should be adjusted to control the incidence of invasive fungal infection.