恶性肿瘤患者放化疗后真菌感染危险因素与耐药分析

Risk factors for fungal infection in cancer patients after chemotherapy of radiotherapy and drug resistance analysis

目的分析恶性肿瘤患者放化疗后真菌感染的菌种分布特征和诱发真菌感染的危险因素以及耐药性,从而对医院真菌感染进行有效的预防和及时的控制。方法对医院2007年9月-2010年6月送检的489份患者痰液、胸腹水、尿液、粪便及血液等标本进行真菌培养及药敏试验分析。结果 489例患者共检查出真菌72株,阳性率为14.72%,其中以白色假丝酵母菌最为常见,占70.83%,其次是热带假丝酵母菌占13.89%;恶性肿瘤放化疗、抗菌药物的滥用,激素及侵入性操作等是真菌感染的危险因素;真菌对所试药物伊曲康唑(ITC)、两性霉素B(AMB)、制霉菌素(NYS)、酮康唑(KET)、益康唑(ECO)、咪康唑(MIC)均有不同程度的耐药性,尤其是ECO和KET,耐药率高达23.61%和26.39%,NYS和MIC的耐药率>12.00%。结论合理应用抗真菌药物,防止滥用,根据药敏试验结果指导临床用药,掌握肿瘤患者治疗过程中引起感染的真菌及耐药性,可以指导临床的合理用药。

OBJECTIVE To analyze the pathogen distribution of specimens causing fungal infection in cancer patients after chemotherapy and chemotherapy and the risk factors that induce fungal infection,so as to effectively prevent and control the fungal infection.METHODS A total of 489 samples of sputum effusion,urine,feces and blood,submitted from Sep 2007 to Jun 2010 were performed the fungal culture and the results of drug susceptibility testing were analyzed.RESULTS Check out a total of 489 cases of patients with 72 strains of fungi,the positive rate was 14.72%（11.2%～16.0%）,of which Candida albicansis most common,accounting for 70.83%,followed by a smooth read cocci 13.89%.Age,overuse of antibiotics,hormones and invasive procedures were risk factors for fungal infection.All fungi showed high resistance rate to various antifungal agents such as itraconazole（ITC）,amphotericin B（AMB）,nystatin（NYS）,enconazole（ECO）,ketoconazole（KET）,miconazole（MIC）,ect.Especially for ECO and KET,the resistance rates were as high as 23.61% and 26.39%.The resistance rates to NYS and MIC were over 12.00%.CONCLUSION To rationally use antifungal agents according to the results of drug susceptibility tests,prevent the abuse of antibiotics and control cancer patients caused by needles during the treatment and drug resistance of pathogens can guide the rational application of antibiotics in clinics.