医院内真菌感染的分布及药物敏感性分析

Analysis on Distribution and Drug Sensitivity of Nosocomial Fungal Infections

目的了解医院内真菌感染分布及药物敏感情况,为预防真菌感染、合理使用抗真菌药物提供依据。方法常规培养分离出真菌,然后接种在科玛嘉显示培养基进行显色,并用法国生物梅里埃公司生产的API20CAUX酵母菌鉴定到种,利用ATB FUNGUS3真菌药敏板条进行MIC法药敏试验。结果湖南省肿瘤医院2008年6月-2011年6月期间,真菌感染来源的主要病区依次是胸部内科(35.2%)、重症监护病房(29.0%)、老干内科(17.4%);真菌感染的标本主要来自痰(69.6%),其次,尿液占9.2%,大便和分泌物各占7.4%、6.8%;在500株真菌中,白色假丝酵母菌占54.6%,其次是热带假丝酵母菌25.8%、近平滑假丝酵母菌9.2%、克柔假丝酵母菌8.2%;500株真菌中,23.08%白色念珠菌(63/273),30.0%非白念(68/227)对5-氟胞嘧啶不敏感;30.8%非白念(70/227)对氟康唑不敏感,其中87.8%克柔念珠(36/41)对氟康唑耐药;17.2%非白念(39/227)对伊曲康唑不敏感;8.4%非白念(19/227)对伏立康唑不敏感;8.8%非白念(20/227)对两性霉素B不敏感。所有白色念珠菌对氟康唑、伊曲康唑、伏立康唑、两性霉素B均敏感。结论临床感染的真菌仍以白色念珠菌为主,非白色念珠菌的感染有上升趋势,药敏结果显示非白念对5-氟胞嘧啶、氟康唑、伊曲康唑产生了较强的耐药性;因此,常规开展真菌药敏试验,进行耐药性监测,可以为预防真菌感染、合理使用抗真菌药物提供依据。

Objective To investigate the distribution and drug susceptibility of nosocomial fungal infections, and to provide the reference for prevention of fungal infections and reasonable use of antifungal drugs. Methods Fungi were cultured and isolated by routine procedure, and then identified by API 20C AUX system. ATB FUNGUS 3 strips were used for MIC sensitivity test. Results The main sources of fungal infections in Hunan Provincial Tumor Hospital from June 2008 to June 2011 were department of thoracic medicine （35.2%）, intensive care unit （29.0%）, and department of internal medicine for the elderly officials （17.4 % ）. The specimens with fungal infections were mainly collected from sputum （69 6 % ）, followed by urine （9.2%）, stool （7.4%） and secretion （6.8%）. Among 500 strains of fungi, Saccharomyces albicans accounted for 54.6%, followed by Candida tropicalis （25. 8 % ）, pen - smooth Candida mycoderma bacteria （ 9.2 % ）, and monilia krusei bacteria （8.2%）. Among 500 strains of fungi, 23.08% of Candida albicans （63/273） and 30.0% of ：non- albicans candida species （68/ 227） were insensitive to 5 - flucytosine, 30.8% of non - albicans candida species （70/227） were insensitive to fluconazole, and 87.8% of monilia krusei bacteria （36/41） were resistant to fluconazole. 17.2% of non-albicans candida species （39/227） were insensitive to itraconazole, 8.4 % of non- albicans candida species （19/227） were insensitive to voriconazole. And 8.8 % of non - albicans candida species （20/227） were insensitive to amphotericin B. All strains of Candida albicans were sensitive to fluconazole, itraconazole, voficonazole, and amphotericin B. Conclusions Most of clinical ftmgal infections were still caused by Candida albicans, but infections due to non - albicans candida species showed an increasing trend. The results of drug sensitivity tests showed that non- albieans candida species had relatively strong endurance to 5 - flucytosine, fluconazole, and itraconazole. Therefore, conducting the antifungal drug susceptibility testing regularly and monitoring drug resistance can provide the reference for fungal infections prevention and rational use of antifungal medicines.