重症急性胰腺炎并发真菌感染的菌群分布及耐药性分析

Analysis of flora distribution and drug resistance in severe acute pancreatitis patients with fungal infection

目的分析该院重症急性胰腺炎(SAP)并发真菌感染的菌群分布特点及对药物敏感的情况,为今后合理用药提供参考。方法采用回顾性分析方法,分析2009年1月至2012年1月该院收治的54例SAP并发真菌感染的临床资料,对分离菌群分布、感染部位、对药物的敏感性等情况进行总结和分析。结果 54例患者累计感染部位78个,检出时间最短6d,最长28d,总的平均感染时间为(15.8±6.5)d,患者年龄分布:≥60岁者为主,占70.4%;感染发生率排前5位的部位依次为肺部(74.1%)、腹腔(51.9%)、胰腺或胰周(44.4%)、胸腔(42.6%)和血液系统(33.3%)。共分离116珠真菌菌株,白色假丝酵母菌最多,占65.5%,其他依次为热带假丝酵母菌(19.0%)、克柔假丝酵母菌(7.7%)、光滑假丝酵母菌(4.3%)和近平滑假丝酵母菌(3.4%)。分离得到的菌株总体对抗菌药物的敏感性由高到低依次为伏立康唑、两性霉素B、5-氟胞嘧啶、氟康唑和伊曲康唑,敏感率分别为97.4%,95.7%,86.2%,77.6%和57.0%。结论重症急性胰腺炎并发真菌感染主要致病真菌菌群以白色假丝酵母菌为主,感染人群以60岁以上的老人为主,肺部为第一感染灶,明确感染菌群及部位有着重要的临床指导意义。

Objective To analyze the flora distribution and drug resistance in severe acute pancreatitis patients （SAP） complicat- ed with fungal infection in our hospital. Methods 54 cases of clinical materials in SAP patients complicated with fungal infection from Jan 2009 to Jan 2012 in our hospital were retrospectively analyzed. Results There were 78 sites suffered by fungal infection. The longest and the shortest detecting time of fungal infection were 28 days and 6 days,respectively. The mean detecting time was （15.8± 6.5） days. Age distribution was mainly above 60 ages old people, accounted for 70.4%. The top five infected bodies sites were lung （74.1%）,abdominal cavity （51.9%）,pancreas or per pancreas （44.4%）,thoracic cavity （42.6%） and hematological system （33.3 % ）. 116 strains were separated. Candida albicans was the main strain （65.5 %） and the following were Candida tropi- calis （ 19.0 % ）, Candida krusei （7.7% ）, Candida glabrata （4.3 % ） and Candida parapsilosis （3.4 % ）. The sequence of drug suscepti- bility from high to low were voriconazole, amphotericin B, 5- fluorocytosine,fluconazole and itraconazole,and the sensitive rate of these drugs were 97.4 %, 95.7 %, 86.2 %,77.6 % and 57.0 %, respectively. Conclusion Candida albican is the main strains in SAP patients complicated with fungal infection. Lung is the first infection site. making sure the infection strains and site are important for clinical treatment.