医院内真菌感染的病原种类和耐药性分析

The clinical distribution and drug resistance analysis of the fungal infection in hospital

目的研究某教学医院侵袭性真菌感染的发病率、耐药性和病原分布特点,为临床医师合理用药提供科学依据。方法回顾分析2008-2010年住院患者真菌培养的检出率、标本来源、菌种分布及其对常见抗真菌药物的耐药性。结果医院内侵袭性真菌感染近3年的检出率19.32%,2008-2010年真菌检出率呈逐年上升的趋势,2008与2009年、2009与2010年差异有统计学意义(χ2=7.61、69.33,P<0.05);感染部位以呼吸道最多,其次为泌尿道;检出的真菌种类以假丝酵母菌属为主,约占99.78%,且白色假丝酵母菌居多,占49.04%。白假丝酵母菌和热带假丝酵母菌对三唑类药物敏感性仍较好,光滑假丝酵母菌及其他两种真菌则对三唑类药物耐药率较高,所有菌株对两性霉素B均较敏感。结论白色假丝酵母菌仍是医院内侵袭性真菌感染的主要病原菌,临床应根据药物敏感试验结果合理使用抗生素,防止侵袭性真菌的发生,延缓其耐药性的进一步发展。

Objective To investigate the infection mobility, the distribution and drug resistance of the fungal infections in hospital,and provide the guideline for the rational using antimicrobial drugs. Method Restrspective analysis of the detection rate,specimen sources,strain distribution and drug resistance cases among the discharged patients from Jan 2008 to Nov 2010. Results The results showed that hospital average incidence of invasive fungal infections accounted for 19.32% in recent three years and it has an increasing secular trend. The incidence of non-C.albicans that arouse invasive infections is increasing year by year. Respiratory tract is the primary site of infection, followed by urinary tract. Candida spp is the main fungal species detected, accounting for 99.78%;Candida albicans accounted for the largest share of 49.04%. The sensitivity of Candida albicans and Candida tropicalis to the drugs of triazole class is still better. But the resistance of Smooth Candida and the other two fungi to drugs of triazole class are high. All strains were sensitive to amphotericin B. Conclusions Candida albicans is still the hospital＇s main pathogen of invasive fungal infections. The hospital should enhance the monitoring of the pathogen and antibiotics should be reasonably selected based on the result of drug sensitivity test in clinic, in order to prevent the present of the invasive fungal infection and deferingthe drug resistance development.