无菌体液感染真菌的分布及耐药性检测

Species distribution and drug resistance of sterile body fluid isolates of fungi

目的回顾性探讨无菌体液感染常见病原性真菌的菌群分布及耐药特点,为临床真菌感染性疾病提供病原学诊断和合理使用抗真菌药物的依据。方法对2012年1月至2013年12月本院临床中从无菌体液中分离的真菌菌株,采用微量稀释法和纸片扩散法检测药物敏感性情况,并对通过血液中分离到的真菌分析,比较两种药敏方法的差异。结果无菌体液标本以血液感染最多见,为92例(占46.5%),198株真菌以白色念珠菌为主(占65.1%),除光滑念珠菌外,分离到的其他主要真菌对抗真菌药物显示了较好的体外活性;微量稀释法和纸片扩散法检测真菌药敏具有较好的一致性,氟康唑和伏立康唑kappa值分别为0.739和0.792。结论无菌体液中真菌感染以白色念珠菌为主,临床应合理使用抗真菌药物:纸片扩散法可代替微量稀释法检测抗真菌药物的体外活性。

Objective To investigate the distribution and drug resistance of fungi isolated from sterile body fluids infection,and to provide the basis and references for clinical treatment and the rational use of antifungal drugs.Methods Fungal strains were isolated from January 2012 to December 2013,antimicrobial susceptibility was determined by microdilution method and disk diffusion method,and the results of the two methods were compared.Results Blood infection was the most common source of sterile body fluid specimens（92 cases）,accounting for 46.5%;Candida albicans was the predominant fungal（65.1%）among the 198 fungal strains.All of the isolates showed good sensitivity to the antifungal drugs except for Candida glabrata.The results of microdilution and disk diffusion method showed good consistency,the kappa of fluconazole and voriconazole were 0.739 and 0.792,respectively.Conclusions Candida albicans was the predominant fungal in sterile body fluids infection,the clinical use of antifungal drugs should be reasonable.Disk diffusion method could replace the microdilution to detect the activity of anti-fungal agents in vitro.