某院2015-2018年住院患儿深部真菌感染的菌群分布及耐药性分析

Distribution and drug resistance analysis of deep fungal infection in hospitalized children from 2015 to 2018 in a hospital

目的了解该院住院患儿深部真菌感染情况及耐药性分布,指导临床合理使用抗真菌药物。方法收集2015年1月至2018年12月深部真菌感染患儿的临床信息,分析其感染分布及耐药性情况。结果 2015-2018年,该院共分离出真菌2 345株,其中白色假丝酵母菌所占比例最高(65.6%),其次为近平滑假丝酵母菌(15.5%)、热带假丝酵母菌(7.1%)、光滑球拟酵母菌(5.0%)、葡萄牙假丝酵母菌(2.7%)等。白色假丝酵母菌、近平滑假丝酵母菌和光滑球拟酵母菌对5-氟胞嘧啶、两性霉素B(AMB)、氟康唑(FCA)、伊曲康唑(ITR)和伏立康唑(VRC)均有90.0%以上的敏感率;热带假丝酵母菌对FCA、ITR和VRC的耐药率较高,达16.3%~18.1%;葡萄牙假丝酵母菌对AMB的耐药率高达92.2%,对其余4种药物的敏感率均在90.0%以上。结论临床分离的真菌对常用抗真菌药物表现出不同的耐药性,临床医生应结合真菌培养及药敏结果合理选择抗真菌药物,准确及时地控制感染,降低真菌耐药率。

Objective To understand the situation of deep fungal infection and the distribution of drug resistance in hospitalized children admitted to the hospital,and to guide the rational use of antifungal drugs in clinical practice.Methods Clinical information of children with deep fungal infections from January 2015 to December 2018 was collected to analyze their infection distribution and drug resistance.Results From 2015 to 2018,2345 strains of fungus were isolated from the hospital,among which the Candida albicans was dominant,accounting for 65.6%,followed by Candida parapsilosis(15.5%),Candida tropicalis(7.1%),Candida glabrata(5.0%),Candida portugal(2.7%)etc.The sensitivity of Candida albicans,Candida parapsilosis and Candida glabrata to 5-fluorocytosine,amphotericin B(AMB),fluconazole(FCA),itraconazole(ITR)and voriconazole(VRC)were more than 90.0%;the resistance of Candida tropicalis to FCA,ITR and VRC was 16.3%-18.1%;the resistance of Candida portugal to AMB was 92.2%and the sensitivity rate of the rest of four drugs were more than 90.0%.Conclusion The isolated fungi have different degrees of drug resistance to commonly used antifungal drugs.Clinicians should use antifungal drugs reasonably based on the results of drug sensitive test,in order to control the infection accurately and timely,reduce the rate of fungal drug resistance.