3759例角膜炎患者真菌检测与耐药性分析

The distribution and drug resistance rate of 3759 cases of fungal keratitis

目的了解角膜感染真菌的分布与药敏情况,为临床诊治提供参考。方法回顾性分析2014年1月至2017年12月在本院就诊的角膜炎患者3759例。进行真菌培养及药敏实验,并汇总分析真菌分布与耐药性。结果 3759例真菌培养出阳性828例,总体阳性率为22%,患者以中老年男性为主,致病真菌以镰刀菌、链格孢霉及曲霉菌为主,其中镰刀菌最多,占比41%(340/828),且有增多趋势;其次为链格孢霉,占比30%(247/828)。真菌培养阳性率具有季节趋势,即在每年的第四季度真菌培养阳性率明显高于其他季度。抗真菌药伏立康唑、两性霉素B、伊曲康唑、酮康唑及氟康唑的耐药率分别为1.2%、1.6%、17.6%、32%及96.1%。结论本院眼角膜真菌感染以镰刀菌、链格孢霉为主且有增多趋势,时间分布呈季节性变化。氟康唑及酮康唑的耐药率较高,临床应根据真菌检验结果合理选择抗真菌药物及治疗方式。

Objective To investigate the pathogenic fungi distribution and drug resistance rate of fungal corneal infection, and to provide reference for clinical diagnosis and treatment. Method Retrospectively analyzed 3759 cases of keratitis patients in Qingdao eye hospital from January 2014 to December 2017. The keratitis patients datas were selected for fungal culture and drug resistance test, the results were collected and analyzed. Results The total positive rate was 22%(828 cases). Most of patients were old men, the most common fungi were Fusarium sp(41%), followed by Alternaria sp(30%). The positive rate of fungal culture in the fourth quarter of the year was significantly higher than those in the other quarters. The drug resistance rates of voriconazole, amphotericin B, itraconazole, ketoconazole and fluconazole were 1.2%, 1.6%, 17.6%, 32% and 96.1%. Conclusion Fungal infection of the cornea was on the rise and seasonal variation. The majority pathogens of fungal keratitis were Fusarium sp,followed by Alternaria sp. The drug resistance rates of fluconazole and ketoconazole were higher than that of other three antifungal drugs.