血液病合并侵袭性真菌感染病原学及危险因素

Pathogenic features and risk factors of invasive fungal infection in patients with hematopathy

目的了解血液病合并侵袭性真菌感染(IFI)的现状,分析真菌耐药情况及感染的危险因素。方法回顾性分析2006—2010年某院血液病科合并感染的患者1 246例次,对IFI患者病原学特点及危险因素进行分析。结果真菌感染281例次,分离真菌162株,感染部位以呼吸道(134株,占82.72%)为主。4种主要酵母菌为白假丝酵母菌、热带假丝酵母菌、光滑假丝酵母菌和克柔假丝酵母菌;2006—2009年均以白假丝酵母菌为主,2010年非白假丝酵母菌超过白假丝酵母菌。4种主要酵母菌对氟康唑和伊曲康唑的总耐药率分别为5.15%和4.41%,6株克柔假丝酵母对氟康唑和伊曲康唑全部耐药,未发现对伏立康唑耐药的菌株。真菌感染的独立危险因素为合并糖尿病、粒缺时间>14 d。结论血液病患者非白假丝酵母菌感染比例增加,出现了耐氟康唑和伊曲康唑的非白假丝酵母菌,需采取综合措施积极预防及早期治疗IFI患者。

Objective To investigate the status of invasive fungal infection（IFI）associated with hematopathy,and evaluate drug resistance and risk factors of fungal infection.Methods 1 246 cases of infection occurred in patients in a hospital from2006 to 2010 were analyzed retrospectively,pathogenic features and risk factors of IFI were analyzed.Results There were 281 cases of fungal infection,and 162 fungal isolates were isolated,the main infection site was respiratory tract（134isolates,82.72%）.Four major Candida were Candida albicans,Candida tropicalis,Candida glabrata,and Candida krusei;in 2006-2009,the main fungi were Candida albicans,while in 2010,the majority were non-Candida albicans.The resistant rates of four isolated Candida to fluconazole and itraconazole were 5.15% and 4.41% respectively,6 isolated Candida krusei strains were all resistant to both fluconazole and itraconazole,voriconazole-resistant strain was not found.The independent risk factors for fungal infection were diabetes and duration time of agranulocytosis〉14 days.Conclusion The proportion of infection caused by non-Candida albicans increased obviously,fluconazole-and itraconazole-resistant non-Candida albicans strains have emerged,comprehensive measures should be adopted to prevent IFI actively and treat patients early.