医院患者深部真菌感染的临床分布与耐药性分析

Clinical distribution and drug resistance of fungi causing deep fungal infections in hospitalized patients

目的了解医院临床分离的真菌分布及耐药性,指导临床合理用药。方法收集医院2013年1-12月临床真菌培养标本,采用法国生物梅里埃公司VITEK-2Compact全自动细菌分析仪进行分离、鉴定和药物敏感试验,采用SPSS16.0进行数据分析。结果 1 024株真菌中白色假丝酵母菌分离率最高为448株占43.8%,最低的是新型隐球酵母菌占0.8%;送检标本以尿液为主占78.1%;送检科室以内科为主,主要为消化内科、重症医学和呼吸内科,其次是泌尿外科;深部真菌感染率年龄段分布构成比差异不大,深部真菌感染率最高的是>60岁老年患者占36.0%;假丝酵母菌属对两性霉素B敏感率最高为100.0%,氟康唑耐药率最高占24.2%,新型隐球酵母菌对伏立康唑和伊曲康唑耐药;伊曲康唑的耐药率随年龄的增加耐药率下降。结论临床标本中真菌感染以白色假丝酵母菌为主,真菌感染主要发生于老年患者,耐药性具有种属间差异,应重视真菌病原学检查和药敏监测。

OBJECTIVE To investigate the distribution and drug resistance of the clinical isolates of fungi so as to provide guidance for reasonable clinical use of antibiotics .METHODS From Jan 2013 to Dec 2013 ,the clinical spec‐imens were collected for culture of fungi ,then the isolation and identification of the fungi were carried out by using VITEK‐2 Compact automatic bacteria analyzer of BioMerieux ,France ,the drug susceptibility testing was per‐formed ,and the data were analyzed with the use of SPSS16 .0 software .RESULTS Of 1 024 strains of fungi isola‐ted ,448 strains were Candida albicans with the highest isolation rate of 43 .8% ,and 0 .8% were Cryptococcus neoformans .The urine specimens were dominant among the submitted specimens ,accounting for 78 .1% .The de‐partment of gastroenterology ,critical care medicine department ,and respiratory medicine department were the predominant internal medicine departments where the specimens were submitted ,followed by the department of u‐rology .The constituent ratio of the age did not vary significantly among the patients with deep fungal infections , the incidence of deep fungal infections was the highest in the elderly patients and was 36 .0% in the elderly patients aged more than 60 years old .The drug susceptibility rate of Candida spp to amphotericin B was the highest （100 .0% ） ,and the drug resistance rate to fluconazole was the highest （24 .2% ）;the C .neoformans was resistant to voriconazole and itraconazole ;the drug resistance rate to itraconazole was decreased with the increase of age . CONCLUSION C .albicans is the predominant species of fungi isolated from the clinical specimens ,and the elderly is the major population with the fungal infections .The drug resistance varies among the different species of fungi . It is necessary to pay attention to the etiological examination and the surveillance of drug susceptibility .