ICU患者深部真菌感染的病原菌分布及耐药性分析

Analysis on distribution of pathogens and drug resistance of deep fungal infection in ICU patients

目的:掌握重症加强护理病房(ICU)患者标本分离培养真菌菌种及其药敏情况,为临床真菌感染的诊疗提供依据。方法:收集2012年1月—2014年12月吉林大学第一医院ICU患者标本分离的真菌,采用回顾性研究方法,按不同年度进行分组,分析菌种分布及常见菌种的耐药情况。菌种鉴定采用VITEK-32系统,药物敏感试验采用Fungus 3真菌药敏试剂盒。结果:共分离出真菌1 563株,2012、2013和2014年分别占全部送检标本的6.4%(439/6 852)、7.2%(444/6 189)和9.8%(680/6 919),真菌检出阳性率逐年升高(χ2=55.918,P<0.05)。白假丝酵母菌构成比最高(49.9%),其次为光滑假丝酵母菌(17.5%)、热带假丝酵母菌(11.1%)和克柔假丝酵母菌(10.1%)。痰是真菌分离的主要标本类型(38.4%),其次为尿(18.2%)、便(15.5%)及引流液(6.8%)。白假丝酵母菌、光滑假丝酵母菌、热带假丝酵母菌和克柔假丝酵母菌对5-氟胞嘧啶均具有良好的敏感性,组间比较差异无统计学意义(P>0.05)。而上述4种真菌对伏立康唑、氟康唑及伊曲康存在不同程度的耐药。结论:ICU患者真菌检出阳性率呈逐年增高的趋势。菌种以白假丝酵母菌为主,标本来源以痰为主,临床常见真菌对抗真菌药物存在一定的耐药性,应加强监测。

Objective： To master the distribution and drug resistance of deep fungal infection in the ICU patients,and to provide the basis for diagnosis and treatment of fungal infection in clinic.Methods： The fungi isolated from the ICU patient samples in First Hospital of Jilin University from January 2012 to December 2014 were collected. Retrospective study was used to analyze the fungal distribution and drug resistance.The strains were identified by VITEK-32 system and drug susceptibility test was performed with Fungus 3.Results： A total of 1 563 fungal strains were isolated,in which 6.4%（439/6 852）,7.2%（444/6189）,9.8%（680/6 919） were isolated from 2012 to 2014. The positive rates of fungal detection we re increased year by year（χ2=55.918,P〈0.05）.The top four fungi were Candida albicans（49.9%）,Candida glabrata（17.5%）,Candida tropicalis（11.1%）,and Candida krusei（10.1%）.The top four samples were sputum（38.4%）,urine（18.2%）,excrement（15.5%）,and drain（6.8%）.The four major Candida were all sensitive to 5-flucytosine,the difference was not significant between groups（P〉0.05）;but they had different resistance to voriconazole,fluconazole,and itraco nazole.Conclusion： The positive rates of fungi are increased every year.The major fungus is Candida albicans,and the major sample is sputum.The common fungi have different resistance to antifungal drugs,and monitoring should be enhanced.