重症监护病房真菌谱及耐药性6年变化趋势

Trends of fungal spectrum and drug resistance changes in Intensive Care Unit

目的 调查我院重症监护室（ICU）近6 a临床分离真菌株的菌种结构及耐药性变化.方法 2007 ～2012年从我院1435例ICU患者中分离出的1 435株真菌均为首次分离的菌株.采用Cox-Stuart趋势检验回顾性分析了分离真菌株的菌种结构和主要真菌对常用抗真菌药物耐药率的变化趋势.结果 2007 ～2012年间,我院tCU真菌检出阳性标本总数从159株/a逐年增加至396株/a.其中,白念珠菌、近平滑念珠菌、曲霉的构成比波动范围分别为34.6％ ～ 50.3％、6.3％～9.6％、1.3％～3.2％,2010 ～2012年较2007 ～2009年构成比总体均有上升趋势,P=0.02.热带念珠菌、光滑念珠菌、克柔念珠菌构成比波动范围分别为13.6％ ～ 17.3％、9.4％ ～ 22.6％、1.4％ ～5.2％,P=0.18,构成比均无明显上升或下降趋势.2010 ～2012年较2007 ～2009年,白念珠菌对氟康唑和伊曲康唑耐药率的变化均呈降低趋势,P=0.02.热带念珠菌对氟康唑和伊曲康唑耐药率的变化均呈降低趋势,P =0.02;光滑念珠菌对伊曲康唑耐药率的变化总体呈上升趋势,P =0.02.结论 我院ICU近6 a来白念珠菌仍然为临床最常见的真菌分离株,白念珠菌、近平滑念珠菌及曲霉占总真菌分离株的百分比有上升趋势.白念珠菌及热带念珠菌对氟康唑和伊曲康唑耐药率均呈降低趋势,光滑念珠菌对伊曲康唑耐药率呈上升趋势.

Objective To investigate the trends of fungal spectrum and drug resistance changes in Intensive Care Unit in six years.Methods One-thousand four hundred and thirty five stains of first-time isolated fungi were isolated during 2007-2012 in ChangZheng Hospital Intensive Care Unit.Cox-Stuart test was used to analysis trends in distribution of fungi and drug resistance changes in this retrospective study.Results During 2007-2012,the number of fungi inspected increased from 159 to 396 strains per year,among which the ratio of Candida albican,parapsilosis,aspergillus ranging 34.6%-50.3 %,6.3%-9.6%,1.3 %-3.2% with a trend of increase,P =0.02 ; Candida tropicalis,glabrata,and krusei ranging 13.6%-17.3%,9.4%-22.6%,1.4%-5.2%,P =0.18;The average drug resistant of Candida albican to itraconazole and fluconazole showed a trend of decrease P =0.02 ;The average drug resistant of Candida tropicalis to itraconazole and fluconazole showed a decreased trend as well,P =0.02 whereas the average drug resistant of Candida glabrata to itraconazoleshowed an increased trend,P =0.02.Conclusion The most common isolated strains of fungi in ICU were Candida albican,followed by Candida tropicalis and Candida glabrata.Candida albican,Candida parapsilosis and Aspergillus had increase ratio of distribution.There are decrease trends in the drug resistance of Candida albican and Candida tropicalis to fluconazole and itraconazole whereas Candida glabrata showed a increase trend to itraconazole