住院患者深部真菌感染的病原菌分布与药敏分析

Distribution and drug susceptibility analysis of 290 strains of deep fungal infections

目的了解住院患者深部真菌感染的现状,病原菌的种类以及病原菌对常用抗真菌药物的敏感性。方法采集我院2012年1月—2014年4月临床疑似感染的住院患者的31 305份血液及体液标本进行培养,对分离出的菌株,采用直接镜检、科玛嘉显色培养基和VITEK-32自动分析仪等进行菌种鉴定;纸片扩散法ATBFUNGUS3真菌药敏板条测试药敏,并收集临床资料进行分析。结果共分离出真菌290株,分离率为0.92%;标本中真菌检出构成比以血液最高(41.03%),其次为尿液(21.38%);真菌检出最高的科室为普通外科(55.82%);真菌构成比依次为白念珠菌31.03%,热带念珠菌17.93%,光滑念珠菌17.59%,近平滑念珠菌13.10%。药敏试验中白念珠菌和近平滑念珠菌对唑类药物的敏感性相对较高。4种常见真菌对两性霉素B和氟胞嘧啶均表现出较高的敏感性。结论血液标本真菌检出构成比最高;普通外科真菌感染患者的分布最多;分离菌株中念珠菌属多见,尤以白念珠菌感染率最高;两性霉素B和氟胞嘧啶的耐药率较低,唑类药物的耐药率较高,各菌种间耐药性存在差异。

Objective To investigate the condition of deep fungal infection, the infection type of pathogen and the sensitivity of the common antifungal drugs. Methods A total of 31 305 blood and aseptic body lfuids specimens of hospitalized patients from Jan 2012 to Apr 2014 were collected, then the isolated and cultured fungi were identiifed by microscopy, CHRO mager medium and VITEK-32 microbe automatic system. The clinical conditions were analyzed and the drug susceptibility was determined by disc diffusion method. Results Totally 290 strains（0.92%） were isolated. The detection rate of the fungal infection in blood was the highest with 41.03%, secondly was the urine with 21.38%. Many specimens came from general surgery department（55.82%）. The strains were constituted with Candida albicans （31. 03%）, C.tropicalis（17.93%）, C.glabrata（17.59%） and C.parapsilosis（13.10%）. Candida albicans and C.parapsilosis were relatively sensitive to zoles. All the four common fungus were sensitive to Amphotericin and Flucytosine. Conclusion Specimens of fungi detected in blood were with the highest constituent ratio, and the distribution of fungal infection in general surgery patients was highest. Candida is the major pathogen which caused deep fungal infection in hospital, especially the C.albicans with the highest infection rate. The drug resistance rates of Amphotericin and Flucytosine are the lowest, while the rate of Fluconazole is the highest. The drug resistance presents a genus difference.