医院内真菌感染的调查及对策

Investigation and countermeasures of nosocomial fungal infections

目的通过调查发生医院内真菌感染的危险因素,以及感染真菌的种类及其对抗真菌药物的敏感性,探讨在临床工作中对医院内真菌感染的控制策略。方法统计分析2009年1月至2010年12月发生的医院内真菌感染患者的相关资料,并对其进行真菌菌种鉴定及药敏试验。结果发生医院内真菌感染的主要危险因素为免疫抑制剂治疗、多种广谱抗生素的使用、气管切开或插管、昏迷、留置导尿、基础疾病等;分离出的真菌主要包括假酵母样真菌和丝状真菌,它们对两性霉素B、制霉菌素、5-氟胞嘧啶和伊曲康唑的敏感性较高,敏感率分别为98.0%、96.4%、91.3%和82.7%,对咪康唑、酮康唑敏感性较差,敏感率分别为61.7%和60.2%。结论接受过免疫抑制剂和多种广谱抗生素治疗、昏迷、体内留置导管的患者容易发生医院内真菌感染。临床医疗中,应加强抗真菌药物的合理应用,尽量减少创伤性操作,以控制医院内真菌感染的发生。

Objective To explore the control strategy to nosocomial fungal infection in clinical work by investigating the risk factors causing nosoeomial fungal infections, fungal types and antimicrobial susceptibility. Methods The related data in the patients with nosocomial fungal infection were statistically analyzed from January 2009 to December 2010. The fungal identification and drug susceptibility test were performed. Results The major risk factors causing nosocomial fungal infection were immunosuppressant therapy,various broad spectrum antibiotics use,trache otomy or intubation,coma,indwelling catheter, basic diseases, etc. The isolated fungi mainly included false yeastlike fungi and filamentous mold,which had the higher sensitivity to amphotericin B,nystatin, 5 flucytosine and itraconazole with the sensitivity rate of 98.0 %, 96.4%, 91.3% and 82.7% respectively, poorer sensitivity to miconazole and ketoconazole with the sensitive rate of 61.7% and 60.2%. Conclusion The patients with immunosuppressive agents and various broad-spectrum antibiotics, coma, body indwelling catheter are prone to nosocomial fungal infection. In the clinical medical treatment, the reasonable use of antibiotics should be strengthened to minimize traumatic operations and control the occurrence of nosocomial fungal infections.