2014～2018年北京协和医院酵母菌血流感染菌种分布和抗真菌药物敏感性分析

Analysis the pathogen distribution and drug susceptibility of yeast bloodstream infection in Peking Union Medical College Hospital from 2014 to 2018

目的分析酵母菌血流感染菌种分布和抗真菌药物的敏感性,为临床诊治提供依据。方法回顾性分析北京协和医院2014年1月~2018年12月血培养鉴定结果为酵母菌的临床资料,对菌种分布、抗真菌药的敏感性、阳性报警时间、科室分布等进行分析。结果血培养中共分离非重复酵母菌206株。真菌瓶、需氧瓶和厌氧瓶酵母菌的阳性检出率分别为1.32%(79/6003),0.43%(371/85855)和0.06%(47/77168)。排在前3位的念珠菌分别为白念珠菌72株(34.95%),热带念珠菌42株(20.39%)和光滑念珠菌39株(18.93%);少见菌包括季也蒙念珠菌、毕赤酵母菌、葡萄牙念珠菌、酿酒酵母、郎比可念珠菌、尼瓦利亚念珠菌、红酵母和希木龙念珠菌。我院酵母菌血流感染好发于>60岁的老年患者(42.23%),男性115例(55.83%)。酵母菌血流感染前3位科室为急诊科41株(19.90%),内科ICU和外科ICU均为36株(17.48%)。阳性报警时间从长到短依次为:光滑念珠菌(55.36±26.87)h,近平滑念珠菌(52.58±45.94)h,白念珠菌(49.17±35.37)h和热带念珠菌(23.38±19.32)h。白念珠菌、光滑念珠菌、近平滑念珠菌和热带念珠菌对氟康唑敏感率分别为98.61%、97.44%、89.66%和71.43%。结论本院酵母菌血流感染以白念珠菌为主,绝大多数念珠菌对抗真菌药具有较高敏感性,热带念珠菌的耐药率相对较高。

Objective To analysis the pathogen distribution and drug susceptibility of yeast blood stream infection, to provide the basis for clinical diagnosis and treatment. Methods Clinical data of Candida blood stream infection was retrospectively analyzed in in Peking Union Medical College Hospital from January 2014 to December 2018. Results A total of 206 non-repetitive yeast strains were isolated from blood culture specimens. The positive isolation rate of yeast from Bactec Mycosis IC/F bottle, aerobic and anaerobic blood culture bottle were 1.32%(79/6003), 0.43%(371/85855)and 0.06%(47/77168) respectively. The top three Candida species were Candida albicans(72, 34.95%), Candida tropicalis(42, 20.39%) and Candida glabrata(39, 18.93%). The uncommon Candida species included Candida guilliermondii,Pichia pastoris,Candida lusitaniae,Saccharomyces cerevisiae,Candida lambica,Candida nivalis,Rhodotorula and Candida Haemulonii.In our hospital,candidemia usually developed in patients aged>60 years(42.23%)and was mostly in men(115,55.83%).Infected patients were mainly from the emergency department(41,19.90%),surgery intensive care unit and internal intensive care unit(both were 36,17.48%).The positive alarm times from long to short was:Candida glabrata [(55.36±26.87)h],Candida parapsilosis[(52.58±45.94)h],Candida albicans[(49.17±35.37)h]and Candida tropicalis [(23.38±19.32)h].The susceptibility rates of Candida albicans,Candida glabrata,Candida parapsilosis and Candida tropicalis to fluconazole were 98.61%、97.44%、89.66% and 71.43%,respectively.Conclusion Candida albicans was the main blood stream infection species in our hospital.Most Candida strains had high sensitivity to antifungal drugs,but the resistance rate of Candida tropicalis was relatively high.