399株医院真菌感染的分布特点及耐药性分析

Fungal pathogens distribution and drug resistance of 399 stains fungi isolated in a hospital

目的了解本院临床常见真菌的种类及常用抗真菌药物的耐药情况,为临床合理使用抗真菌药物提供依据。方法对2014年1月至2015年12月临床采集的标本进行真菌分离培养,采用科玛嘉念珠菌显色培养基及API 20C AUX酵母菌鉴定试剂盒进行真菌鉴定,ATB Fungus 3药敏试剂盒进行药敏试验,统计分析菌种的构成及其对5种抗真菌药物的敏感率。结果共收集培养得到399株真菌,标本类型以尿液为主,念珠菌中以白色假丝酵母菌为主,共188株,占47.1%;丝状真菌中以烟曲霉菌为主,共25株,占6.3%。白色念珠菌对抗真菌药物的敏感性较好,大部分在95%以上,但光滑念珠菌对唑类药物敏感性相对较低,对氟康唑的敏感性只有65.1%。曲霉菌对两性霉素B、伊曲康唑和伏立康唑均有着较高的敏感性。结论医院真菌感染以白色念珠菌为主,两性霉素B和5-氟胞嘧啶对其有较高的抗菌活性;光滑念珠菌对唑类药物有较高的耐药性,临床应根据药敏结果合理使用抗真菌药物。

Objective To understand common fungal species and antifungal drug resistance in our hospital and to provide important evidences for rational use of antifungal agents in clinical practice. Methods We performed fungal culture for clinically collected specimens from January 2014 to December 2015,and used CHROMagar Candida chromogenic medium and API 20 C AUX yeast identification kit to identify fungal species. ATB Fungus 3 susceptibility kits were used to test drug susceptibility. At last,we counted the composition of fungal species and sensitive rates of 5 kinds of antifungal drugs. Results We obtained a total of 399 strains of fungi. Urine was the main sample of clinical specimen and Candida albicans were the main strain（ 188 strains,accounting for 47. 1%） in Candida. In filamentous fungi,Aspergillus fumigatus were the main strain（ 25 stains,accounting for 6. 3%）. The sensitivity of Candida albicans to antifungal drugs was more than 95%,but the sensitivity of Candida glabrata to azole was relatively low and only 65. 1% for fluconazole. Aspergillus had a high sensitivity to amphotericin B,itraconazole and voriconazole. Conclusion Candida albicans was the main hospital fungal infection and amphotericin B and 5-flucytosine had high antifungal activity against this fungus. Candida glabrata had a higher resistance to azoles and clinically reasonable use of antifungal drugs according to the results of drug susceptibility is very important.