侵袭性念珠菌的临床表现及药敏情况分析

Analysis of Clinical Manifestations and Drug Sensitivity of Invasive Candida

目的研究在于了解患有侵袭性念珠菌患者的临床症状以及药敏情况。方法查阅病例资料了解临床症状;运用ATB FUNGUS药敏板条实验了解菌株的药敏情况。结果样本主要来源于中段尿(34.33%)、咽拭(30.90%)和痰(18.03%)当中,ICU中以白念珠菌为主,内科中以热带念珠菌为主。最常见的并发症包括肺部感染(73.82%)、高血压病(63.09%)、心血管疾病(51.07%)、脑梗死(46.35%)。危险因素主要包括抗生素的使用(88.84%)、中心静脉置管(60.52%)、尿导管(59.66%)、手术史(54.94%)和胃管插管(51.93%)。中医辨证中实证所占比例最高(69.60%)。70~85岁的患者病死率最高(30.39%)中医辨证中,虚证患者的病死率最高(39.29%),科室分布中ICU中病死率最高(38.32%)。药敏试验显示,9.01%的念珠菌对氟康唑具有抗药性,7.3%的念珠菌对伊曲康唑表现为非野生型,11.59%的念珠菌对伏立康唑表现为非野生型。结论由于收集到感染念珠菌的患者年龄偏大,以ICU科室居多,合并基础疾病较多,增加了感染机会。光滑念珠菌的病死率最高,并且基础疾病和危险因素都与病死率相关。分离菌中具有耐药菌株,以及念珠菌对唑类药物具有天然耐药性,为治疗和预后增加了困难。

Objective The purpose of this study is to understand the clinical symptoms and drug sensitivity of patients with invasive Candida.Methods The case data was checked to understand the clinical symptoms.The ATB FUNGUS drug susceptibility test was used to understand the drug susceptibility of the strain.Results The samples were mainly derived from midstream urine(34.33%),throat swabs(30.90%)and sputum(18.03%).Candida albicanswas mainly in the ICU and Candida tropicalis in internal medicine.The most common complications included lung infection(73.82%),hypertension(63.09%),cardiovascular disease(51.07%)and cerebral infarction(46.35%).The risk factors mainly included the use of antibiotics(88.84%),central venous catheterization(60.52%),urinary catheters(59.66%),surgical history(54.94%)and gastric tube intubation(51.93%).The proportion of empirical evidence in the dialectics of TCM was the highest(69.60%).Patients aged 70-85 had the highest mortality rate(30.39%).Among traditional Chinese medicine dialectics,patients with deficiency syndrome have the highest mortality rate(39.29%).Among the departments,the mortality rate was the highest(38.32%)in the ICU.The drug sensitivity test showed that 9.01%of Candida were resistant to fluconazole,7.3%of Candida were non-wild type to itraconazole,and 11.59%of Candida were non-wild type to voriconazole.Conclusion Patients infected with Candida are older,most of whom are in ICU departments,and have more underlying diseases,which increases the chance of infection.The isolates contain drug-resistant strains,which increases the difficulty of treatment and prognosis.Statistical analysis has found that cardiovascular diseases,sepsis,cerebral infarction,tumors and digestive tract diseases are increase the difficult of prognosis.