真菌血症患者临床特点及真菌分析

Clinical characteristics of patients with fungemia and distribution of fungi

目的分析真菌血症患者的临床特点及真菌分布,为临床诊疗提供参考。方法收集2006-2011年血液科病房27例真菌血症患者的临床资料进行回顾性分析,真菌的培养与鉴定采用Bact/Alert 240快速培养监测系统及BacT/Alert培养瓶,仪器报警阳性时转种哥伦比亚血、巧克力琼脂、萨布罗平板,酵母的鉴定采用API 20C AUX酵母鉴定条。结果真菌血症患者存在免疫功能低下,占92.59%,患者接受过化疗、大剂量糖皮质激素和环孢素治疗,占77.78%,中性粒细胞缺乏患者,占62.96%;血培养阳性前有77.78%患者使用≥2种广谱高效抗菌药物>1周;致病真菌中以假丝酵母菌属为主,占77.78%,其中热带假丝酵母菌占37.04%;病死率37.04%。结论真菌血症多发生于免疫功能缺陷者,临床表现缺乏特异性,血培养对于诊断至关重要;致病真菌中以假丝酵母菌属为主,真菌血症病死率高,对于高危患者,需要积极预防。

OBJECTIVE To analyze the clinical characteristics of the patients with fungemia and the distribution of fungi so as to provide guidance for clinical diagnosis and treatment. METHODS The clinical data of 27 patients with fungemia who were treated in the wards of hematology department from 2006 to 2011 were collected and retrospectively analyzed. then the fungi were cultured and identified with the use of Bact/Alert 240 rapid culture and surveillance system and the BacT/Alert culture flasks; the identified fungi were transferred to Columbia blood. Chocolate agar, and Sabouraud flat when the equipments alarmed positive. and the identification of yeast was performed with the use of API20 C AUX yeast identification strip. RESULTS The fungemia patients with low immune function accounted for 92. 59 %; the patients who have received chemotherapy and the treatment with large dose of corticosteroids or cyclosporine accounted for 77. 78%; the patients with agranulocytosis accounted for 62.96%. Before the blood was cultured positive. 77.78% of the patients have used two broad-spectrum antibiotics for more than one week. Among the pathogenic fungi isolated. the Candida was dominant （77.78%） , among which the Candida tropicalis accounted for 37.04 %. The mortality rate was 37.04 %. CONCLUSION The fungemia is a complication of immunocompromised patients. and the clinical manifestations are lack of specificity; the blood culture is crucial to the diagnosis; the Candida predominates the pathogenic fungi; the mortality rate of the fungemia patients is high; the prevention measures should be actively taken for the high-risk patients.