念珠菌血症的菌种分布与诊疗进展

The species distribution of candidemia and the advances on diagnosis and treatment

临床上念珠菌血症发生率在不断升高，为临床治疗带来了严峻挑战。致病菌种以白念珠菌为主，同时近平滑念珠菌、热带念珠菌、光滑念珠菌等非白念珠菌的感染比率逐步上升。除血培养外，其他诊断方法如β-D-葡聚糖检测试验、PCR、抗原抗体反应等新诊断方法为初始的经验性治疗提供了帮助。针对菌种变化及耐药性问题，念珠菌血症首选棘白菌素类药物治疗，同时应关注抗真菌药物不规范应用的问题。

Candidemia is one of the challenges in clinical treatment because of the rising incidence rate. The most common pathogen of candidemia is C.albicans, in the same time incidence rate of non-C.a/b/cans such as C.parapsilosis, C.tropicalis, C.glabrata, and C.krusei are escalating. Except blood culture, novel diagnostic methods such as β-D-glucan （BDG）, PCR assays and mannan/anti-mannan immunoglobulin G are helpful in empirical therapy. As the changes in Candida species and drug resistance, echinocandins are the first choice for patients. Meanwhile the inappropriate drug use in clinical treatment should be highlighted.