老年患者泌尿系真菌感染菌群分布与耐药性分析

Species distribution and drug-resistance analysis of urinary fungal infections in older adults

目的 分析北京医院2011—2013年门诊入院60岁以上患者泌尿系统感染真菌的检出率、菌种分布和耐药性，为临床合理使用抗真菌药物提供依据。方法 选取我院老年患者263例，平均年龄79.6岁，用无菌方法留取患者中段尿或膀胱穿刺尿进行真菌培养，采用API20C AUX进行鉴定，用梅里埃药敏试剂条测定药敏试验。 结果 2 983份尿液样本中，共分离真菌263株，其中热带念珠菌92株，光滑念珠菌85株，白色念珠菌77株，其他念珠菌9珠；对氟康唑的耐药率分别为13株（14.1%）、32株（37.6%）和12株（15.6%），对伊曲康唑的耐药率分别为15株（16.3%）、30株（35.3%）和7株（9.1%），对两性霉素未发现耐药菌株。结论 北京医院泌尿系感染真菌分离率为8.8%，以光滑念珠菌、热带念珠菌和白色念珠菌为主，前者对唑类药物具有较高的耐药率，后两者对唑类药物敏感性较好，三者对两性霉素均敏感。

Objective To analyze the detection rates, species distribution and drug-resistance of urinary fungal infection in elderly patients at Beijing Hospital from 2011 to 2013, in order to provide the basis for the reasonable clinical use of anti-epiphyte medicines. Methods Totally 263 patients with an average of 79.6 years old were collected from Beijing Hospital. The urine from freshly voided midstream or bladder puncture was collected under aseptic condition for fungal culture, then the strains of epiphytes were identified by using API 20C AUX. The drug sensitivity was tested with ATB fungus3. Results 263 strains of epiphytes were isolated from the 2 983 urine samples, of which 92 were C. tropicalis, 85 were C. glabrata, 77 were Candida albican, and 9 were other fungus candida. The rates of drug resistance to fluconazole were 14.1% （13 strains）, 37.6 % （32 strains） and 15.6 （12 strains）, and to itraconazole were 16.3%（15 strains）, 35.3%（30 strains） and 9.1%（7 strains）, respectively. All of the 263 strains were not found to have drug resistance to amphotericin. Conclasions The isolation rate of urinary fungal infections is 8.8% in Beijing Hospital. The majority of the tested fungal are C. glabrata, C. tropicalis and Candida albican, the former has higher resistance rate to azoles, and the two latter have better sensitivity to azole, and all of them have the sensitivity to amphotericin.