ICU血流真菌感染的菌群分布及耐药性分析

Distribution and drug resistance of fungi in ICU patients with fungal bloodstream infection

目的:监测我院ICU血流真菌感染的菌种分布和耐药情况,为临床合理用药提供依据。方法:收集我院ICU2010年1月至2012年12月送检病原学标本,其中包括全血和导管血标本。所有标本先用BDBACTEC9120/9240全自动血培养仪进行培养,出现阳性报警后接种血平板、麦康凯、巧克力板、沙保弱培养基对病原菌进行分离,其中真菌鉴定采用科玛嘉念珠菌显色培养基及VITEK2-compact鉴定仪的YST卡进行菌种的鉴定,药敏试验采用纸片琼脂扩散法(K-B法)。结果:22653份血培养共分离出真菌60株,分离率0.26%,其中白念珠菌20株(33.33%),近平滑念珠菌12株(20.00%),热带念珠菌10株(16.67%),光滑念珠菌6株(10.00%),对氟康唑的耐药率分别为:3.1%、2.3%、8.7%和56.8%,对两性霉素B和伏立康唑均较敏感。结论:ICU血流真菌感染的病原菌以白念珠菌为主,光滑念珠菌对氟康唑的敏感率较低,尚未发现对两性霉素B和伏立康唑耐药的菌株。

Objective To investigate the distribution and drug resistance of fungi in ICU patients with fungal bloodstream infection and to provide the evidence for rational clinical treatment.Methods The specimens of pathogens including whole blood and blood from catheters detected from January 2010 to December 2012 were collected.All the specimens were first cultured by the BD BACTEC9120 /9240 automated blood culture system.The pathogens inoculated in blood agar,MacConkey,chocolate plate,and Sobaurand＇s agar medium were isolated after presence of positive alarms.Fungi was then identified with the CHROMagar Candida chromogenic medium and YST card of the VITEK 2-compact identification instrument,Disk agar diffusion method（K-B method） was used for the susceptibility test.Results 60 fungal strains were isolated from 22,653 blood specimens,with a rate of 0.26%.Of the 60 isolates,20（33.33%） were Candida albicans,12（20.00%） were C.parapsilosis,10（16.67%） were C.tropicalis,and 6（10.00%） were C.glabrata;and the rate of drug resistance to flueonazole was 3.1%,2.3%,8.7%,and 56.8%,respectively.All the isolates were sensitive to amphotericin B and voriconazole.Conclusions The pathogens isolated from ICU patients with bloodstream infection are mostly C.albicans.Candida glabrata has a higher rate of drug resistance to fluconazole.No strains with resistance to amphotericin B and voriconazole are found.