重症监护病房真菌感染的病原菌分布与耐药性分析

Pathogen Distribution and Drug Resistance of Fungal Infections in Intensive Care Unit

目的:对重症监护病房(ICU)内真菌感染的常见菌种、感染部位及耐药情况进行分析,为指导临床合理使用抗真菌药提供病原学依据。方法:回顾性调查我院ICU2009-2010年660例患者的病历,对真菌感染种类、菌种的分布及耐药性进行统计分析。结果:660例患者中发生真菌感染98例,占14.8%,以呼吸道感染为主,占50.0%;其次为泌尿道感染,占43.4%。各种感染性标本共分离真菌106株,主要为白色假丝酵母菌(51.9%)、热带假丝酵母菌(34.0%)和光滑假丝酵母菌(9.4%);对氟康唑、伊曲康唑、伏立康唑具有较高的耐药性(耐药率≥47.2%),对两性霉素B、5-氟胞嘧啶、制霉菌素比较敏感(敏感率≥81.8%)。结论:应重视对真菌的培养鉴定和药敏试验,积极开展真菌耐药性监测,密切关注真菌的耐药变迁,合理选择抗真菌药物,防止和延缓菌株耐药性进一步扩大。

OBJECTIVE：To analyz the common bacteria,their pathologic sites and drug resistance of fungal infection in the intensive care unit （ICU）,and to provide etiological basis for rational use of antifungal agents.METHODS：Medical records of 660 patients in ICU were investigated in our hospital from 2009 to 2010 retrospectively.The fungal infections species,strains distribution and drug-resistance were analyzed statistically.RESULTS：Fungal infections were found in 98 cases （14.8%）.The respiratory tract infection accounted for 50.0% and urinary tract infection for 43.4% in the 98 cases.A total of 106 strains of fungi were isolated,in which Candida albicans,C.tropicalis and C.glabrata accounted for 51.9%,34.0% and 9.4%.To fluconazole,itraconazole,voriconazole there was a high resistance （resistance rate≥47.2%）;to amphotericin B,5-fluorouracil,nystatin they were sensitive （sensitivity rate≥81.8%）.CONCLUSION：We should pay attention to the cultivation of fungi identification and susceptibility test,actively carry on fungal drug resistance monitoring,and pay close attention to changes in fungal resistance.Make a reasonable choice of antifungal agents to prevent and delay further expansion of drug-resistant strains.