50例真菌血流感染患者病原菌的分布及其耐药特点分析

Analysis on Pathogen Distribution and Drug Resistance in 50 Patients with Fungal Bloodstream Infection

目的:分析医院真菌血流感染的危险因素、病原菌的分布与药敏特点。方法:选取医院2015年1月—2019年12月被确诊为真菌血流感染患者50例病历资料,统计与分析其真菌血流感染的危险因素、病原菌的分布与药敏试验结果对用药的影响。结果:50例真菌血流感染患者标本中,检出真菌50株,其中白假丝酵母16株(占32.00%)、热带假丝酵母15株(占30.00%)、光滑假丝酵母6株(占12.00%)、近平滑假丝酵母6株(占12.00%)、葡萄牙假丝酵母1株(占2.00%)、无名假丝酵母3株(占6.00%)、新生隐球菌2株(占4.00%)和罗伦特隐球菌1株(占2.00%);所有假丝酵母对两性霉素B、伏立康唑较为敏感,光滑假丝酵母对氟康唑、伊曲康唑耐药,新型隐球菌对伏立康唑及伊曲康唑耐药;在老年群体中,合并心血管疾病和肺部疾病真菌血流感染的比例较高;青年及以下年龄段的群体中,合并脑血管疾病及其他非基础疾病则占据了较高的比例;真菌血流感染的发生率与使用≥2种广谱抗菌药物>1周及合并≥2种危险因素之间具有相关性;卡泊芬净和氟康唑在抗真菌血流感染中使用率分别为53.45%和41.38%。结论:真菌血流感染以白假丝酵母为主,但非白假丝酵母比例明显升高;真菌血症的老年群体多伴有心肺等基础疾病,而青年及以下年龄段群体更多地发生在脑血管疾病和其他非基础疾病后,临床应高度重视。

Objective:To analyze the risk factors of nosocomial fungal bloodstream infection, the distribution of pathogenic bacteria and the characteristics of drug sensitivity. Methods:The medical records of 50 patients diagnosed with fungal bloodstream infection in hospital from January 2015 to December 2019 were selected, and the risk factors of fungal bloodstream infection, the distribution of pathogenic bacteria and the influence of drug sensitivity test results on drug use were statistically analyzed. Results:In 50 cases of fungal bloodstream infection, 50 strains of fungi were detected. In them, there were 16 strains of Candida albicans(32.00%), 15 strains of Candida tropicalis(30.00%), 6 strains of Candida smoothing(12.00%), 6 strains of Candida near-smoothing(12.00%), 1 strain of Candida Portugal(2.00%) and3 strains of Candida namocii(6.00%), 2 strains of Cryptococcus neoformans(4.00%) and 1 strain of Cryptococcus lorente(2.00%). All Candida were sensitive to amphotericin B and voriconazole, Candida smooth was resistant to fluconazole and itraconazole, and Cryptococcus neoformans were resistant to voriconazole and itraconazole.In the elderly population, the proportion of fungal bloodstream infections with cardiovascular disease and pulmonary disease was higher.The incidence of cerebrovascular diseases and other non-basic diseases was higher in young people and below age group.The incidences of fungal bloodstream infection were correlated with the elderly patients with basic diseases easily causing immunodeficiency, the use of greater than for 1 week with ≥ 2 kinds of broad-spectrum antibacterials, indwelling venous catheter and greater than 2 kinds of risk factors. The rates of antifungal bloodstream infection were 53.45% and41.38% respectively for caspofungin and fluconazole. Conclusion:The fungal bloodstream infection was mainly Candida albicans, but the proportion of non-Candida albicans increased significantly. Fungemia is associated with basic diseases such as heart and lung in the elderly, while cerebrovascular diseases and other non-basic diseases were more common in the young and below age groups. Therefore, clinical attention had to be paid to fungemia.