某三甲医院3090株真菌感染病原菌的临床分布及耐药性分析

Analysis of Clinical Distribution and Drug Resistance of 3090 Strains of Fungal Infection Pathogens in a Third Class Hospital

目的了解某三甲医院2012—2018年真菌感染分离株的临床分布特点及耐药规律,为临床合理使用抗生素及抗真菌药物提供依据。方法回顾性调查宁夏回族自治区人民医院2012—2018年3090株真菌感染的病原菌,并使用WHONET 5.6软件对病原菌的分布及药敏进行分析。结果我院真菌感染排名前3位的病区依次为呼吸内科(33.11%)、ICU(14.11%)和综合内科(7.18%);真菌感染的主要人群为≥65周岁的老年患者,占感染总人数的74.37%;念珠菌属真菌感染位居前3位的依次为白念珠菌2072株(67.06%),光滑念珠菌329株(10.65%),热带念珠菌305株(9.87%),丝状真菌以曲霉菌和镰刀菌居多;最常见的感染部位为呼吸道,占感染总数的72.78%;2012—2018年白念珠菌感染数量有明显下降,构成比从80.76%降低至49.85%,而其他真菌有不同程度增高趋势;目前所有念珠菌未检出两性霉素B耐药株,三唑类药物对于白念珠菌具有高度抗菌活性,对于非白念珠菌具有一定抗菌活性(除克柔念珠菌对氟康唑天然耐药外),5-氟胞嘧啶对所有念珠菌均具有良好的抗菌活性(除克柔念珠菌外)。结论对于真菌感染的患者应结合实验室真菌药敏结果合理使用抗真菌药物,同时应高度重视耐药株的监测。

Objective To understand the clinical distribution characteristics and drug resistance rules of fungal infection isolates in a class A hospital from 2012 to 2018,so as to provide evidence for rational use of antibiotics and antifungal drugs in clinical practice.Methods Retrospective investigation was conducted on 3090 strains of fungal infection in our hospital from 2012 to 2018,and WHONET 5.6 software was used for statistical analysis of the distribution of pathogens and drug susceptibility.Results The top three fungal infection wards in our hospital were Respiratory department(33.11%),Intensive care unit(14.11%)and General department of medicine(7.18%).The main population infected by the fungus was elderly patients≥65 years old,accounting for 74.37%of the total number of infections.The top three fungal infections of candida were 2072 strains of C.albicans(67.06%),329 strains of C.glabrata(10.65%),and 305 strains of C.tropicalis(9.87%).Aspergillus and fusarium were the majority of filamentous fungi.The most common infection site was the respiratory tract,accounting for 72.78%of the total number of infections.From 2012 to 2018,the number of C.albicans infection decreased significantly,the constituent ratio decreased from 80.76%to 49.85%,while other fungi showed a trend of increasing in different degrees.At present all candida detection amphotericin B not resistant strains,triazole drugs for C.albicans with high antibacterial activities,has certain antibacterial activity for the non-C.albicans to fluconazole(except that C.krusei is naturally resistant to fluconazole),5-fluorine cytosine to all candida has good antibacterial activity(except C.krusei).Conclusion Rational use of anti-fungal drugs should be combined with the results of fungal susceptibility in the laboratory,and high attention should be paid to the monitoring of drug-resistant strains.