血液真菌感染的菌群分布及耐药监测分析

Distribution and drug resistance of fungi in blood

目的:了解本院血液真菌感染的菌种分布和耐药情况,为临床用药提供依据。方法:收集2008年1月-2011年12月4年间住院患者的血液标本,经BacT/ALERT 3D血培养仪培养,血琼脂培养基及沙保弱培养基分离培养真菌,用念珠菌显色培养基和ID32C鉴定板条进行菌种鉴定,ATB FUNGUS3微量稀释板测定药敏。结果:14752份血液标本共分离出150株真菌,分离率为1.02%,其中以白假丝酵母菌为主,占39.33%,其次为热带假丝酵母菌,占26.67%。药敏实验发现真菌对氟康唑和伊曲康唑耐药性较高(5.4%和2.7%),对5-氟胞嘧啶和伏立康唑较为敏感(99.3%和97.3%),对两性霉素均为敏感。结论:我院血液真菌感染分离株多数为假丝酵母菌属真菌,对氟康唑和伊曲康唑的抗菌活性下降,建议治疗首选两性霉素和5-氟胞嘧啶。

Objective： To investigate the distribution and drug resistance of fungi in blood and provide the evidence for clinical therapy.Methods： The blood was collected in Lishui hospital between January 2008 and December 2011,cultured with BacT/ALERT 3D.The fungi were isolated with blood agar plate and Sobaurandps agar culture medium,identified with CHROM agar colored medium and ID32C.The susceptibility test was then performed with ATB FUNGUS 3 micro dilution plate.Results： There were 150 fungal isolates of the 14752 blood specimens,and the isolating rate was 1.02%.The prevalence of C.albicans was the main type of the isolates（39.33%）,and followed by C.tropicalis（26.67%）.Fungi was high resistance to fluconazole and itraconazole,reaching 5.4% and 2.7%,respectively.Flucytosine and voriconazole,reaching 99.3% and 97.3%,respectively.All isolates were sensitive to amphotericin B.Conclusion：In Lishui hospital,the majority of fungi separated from blood were candida species.Antifungi activity of Flucytosine and voriconazole were lower than others,amphotericin B and 5-flucytosine were still recommended as the first choice for fungemia treatment.