院内念珠菌血液感染的菌种分布及药敏分析

Analysis on pathogenic distribution and sensitivity of nosocomical candidemia

目的分析我院念珠菌血液感染的菌种比例、科室分布和体外药敏情况,为临床抗真菌药物的选择提供支持。方法回顾性分析无锡市第二人民医院在2013~2016年间血培养结果为念珠菌的病例,统计菌种分布及药敏结果等。结果血培养标本中念珠菌阳性病例共有56例,其中白念珠菌比例为57%(32/56),非白念珠菌占43%(24/56)。非白念珠菌菌株主要为近平滑念珠菌(20%,11/56)和光滑念珠菌(15.8%,9/56)。念珠菌感染病例主要分布在重症监护科(23.2%,13/56)和肾内科(17.9%,10/56)。白念珠菌与非白念珠菌对临床最常用的抗真菌药物氟康唑的敏感率差别最大,分别为93.8%和62.5%;56株念珠菌菌株对抗真菌药物两性霉素B和5-氟尿嘧啶的敏感性均为100%;55.6%的光滑念珠菌和72.7%的近平滑念珠菌对氟康唑敏感,所有克柔念珠菌株对氟康唑均耐药。结论本院近几年念珠菌血液感染的病原菌仍以白念珠菌为主,但非白念珠菌对一线抗真菌药物氟康唑的耐药性更高,临床上抗真菌的药物选择应充分考虑耐药问题。

Objective To investigate the pathogen distribution and drug resistance of Candida bloodstream infection.Methods The data of Candidaisolated from blood culture were retrospectively analyzed in the Wuxi No.2 People＇s Hospital from 2013 to 2016.Results Fifty-six pathogenic Candida strains were isolated,which included Candida albicans（57%,32/56）,Candida parapsilosis（20%,11/56）and Candida glabrata（15.8%,9/56）.The patients mainly came from the ICU（23.2%,13/56）and the department of Nephrology（17.9%,10/56）.The difference of sensitivity rates between Candida albicans and non-albicans candida was notable,which were 93.8% and 62.5%.The sensitivity rates of 56 Candida strains to amphotericin B and flucytosine were 100%.The sensitivity rates of Candida glabrataand Candida parapsilosis to fluconazole were 55.6% and 72.7%.All the Candida krusi strains were resistance to fluconazole.Conclusions The main pathogenic Candidaisolated from bloodstream infection was Candida albicans.The sensitivity tests showed that non-albicans candida species had relatively strong endurance to fluconazole.Therefore,drug resistance should be considered in the selection of antifungal drugs.