550例无菌部位真菌感染的临床分布及耐药性分析

Clinical distribution and drug resistance analysis of 550 cases of fungal infection in aseptic sites

目的分析我院临床常见无菌部位真菌感染的种类及耐药性特点,为临床病原学诊断及合理使用抗真菌药物提供依据。方法收集我院2016年1月～2017年10月住院及门诊送检的无菌部位进行培养,分离出真菌并鉴定到种,对常见真菌进行药敏试验分析。结果在分离出的550株真菌标本中,感染阳性标本前4位分别是:尿液(73.5%,404/550)、各种分泌物(10.9%,60/550)、血液(9.8%,54/550)、胸腹水及引流液(4.5%,25/550);本院真菌分离率前5位的菌种分别是白色念珠菌(37.09%,204/550)、光滑念珠菌(27.82%,153/550)、热带念珠菌(15.64%,86/550)、近平滑念珠菌(10.55%,58/550)、马尔尼菲青霉菌(2.18%,12/550);真菌分离率前三位的科室分别是:泌尿外科病区(16.2%,89/550)、地方老年病病区(13.5%,74/550)、干部病房病区(8.73%,48/550)。常见真菌对常见抗真菌药物的敏感率由高到低依次为:两性霉素B(99.25%,531/535)、制霉菌素(99.24%,521/525)、5-氟胞嘧啶(92.9%,497/535)、卡泊芬净(87.84%,448/510)、伊曲康唑(86.46%,466/539)。结论无菌部位的真菌感染以白色念珠菌为主,两性霉素B、制霉菌素及5-氟胞嘧啶均具有较强的抑制真菌作用,临床医生应重视实验室真菌培养与鉴定结果,合理使用抗真菌药物。

Objective In order to provide the basis for the diagnosis of clinical etiology and the rational use of antifungal drugs,the species and drug resistance characteristics of common aseptic sites in our hospital were analyzed.Methods The sterile parts of our hospital from January 1,2016 to October 30,2017 were collected,and fungi were identified and identified.The susceptibility tests of common fungi were carried out.Results In 550 strains of fungi were isolated from the infected specimens,the top 4 are: the urine (73.5%,404/550),various secretions (10.9%,60/550),blood (9.8%,54/550),thoracic drainage fluid and ascites (4.5%,25/550);the fungal isolation rate of the top 5 strains respectively.Is Candida albicans (37.09%,204/550),Candida glabrata (27.82%,153/550),Candida tropicalis (15.64%,86/550),c.parapsilosis (10.55%,58/550),Penicillium marneffei (2.18%,12/550);fungal isolation rate of the top three departments are: Department of urology ward (16.2%,89/550),where the elderly disease areas (13.5%,74/550),cadre ward ward (8.73%,48/550).Common fungal susceptibility rate to common antifungal drugs from high to low: amphotericin B (99.25%,531/535) and nystatin (99.24%,521/525),5-fluorocytosine (92.9%,497/535) and caspofungin (87.84%,448/510),itraconazole (86.46%,466/539).Conclusion The fungus infection in the aseptic part is mainly Candida albicans.Amphotericin B,nystatin and 5-fluorcytosine have strong inhibitory effect on fungi. Clinicians should pay attention to the results of laboratory fungus culture and identification,and make rational use of antifungal agents.