医院念珠菌尿路感染菌株分布及耐药性分析

The distribution and drug resistance analysis of urinary tract Candida infectons in hospital

目的探讨医院念珠菌尿路感染的菌群分布及耐药性情况,为抗菌药物选择提供参考。方法回顾性分析2018年1月—2020年12月我院念珠菌泌尿系感染患者的中段尿培养阳性结果(菌株鉴定和药敏试验)及临床资料。结果212例患者中共分离出念珠菌256株,其中男性102例,女性110例,平均年龄为71.7±14.2岁。其中白念珠菌101株、热带念珠菌76株、光滑念珠菌31株占分离株的前3位,前3种念珠菌占总分离菌的81.2%。内科检出的菌株中以白念珠菌为主,菌株外科检出中以热带念珠菌为主,差异具有统计学意义(P<0.05)。所有菌株对两性霉素B和氟胞嘧啶敏感,非白念珠菌对唑类抗真菌药敏感性较差,其中近平滑念珠菌、热带念珠菌在外科及ICU的耐药问题更为严重,差异具有统计学意义(P<0.05)。结论我院念珠菌尿路感染内科、外科主要菌株不同,内科以白念珠菌为主,外科以热带念珠菌为主。热带念珠菌对唑类敏感性最低,且对氟康唑及伏立康唑的耐药性在外科病房和重症监护病房表现得更为严重。临床上内科经验性治疗可首选氟康唑,对于外科及重症患者建议应考虑首选两性霉素B和/或氟胞嘧啶进行治疗。

Objective To investigate the distribution and drug resistance of urinary tract fungal infectons in hospital,so as to provide reference for the selection of antimicrobial agents.Methods Retrospective analysis of the relevant clinical and laboratory data of patients with Candida urinary tract infection in First Hospital of Qinhuangdao from January 2018 to December 2020 was performed.Results A total of 256 fungal strains were isolated from 212 patients,including 102 males and 110 females,with an average age of 71.7±14.2 years.Among them,101 Candida albicans strains,76 Candida tropicalis strains,and 31 Candida glabrata strains accounted for the top 3 isolates,and the first 3 Candida species accounted for 81.2%of the total isolates.The detection rate of Candida albicans in internal medicine was higher than that in surgical wards,while the detection rate of Candida tropicalis in internal medicine wards was lower than that in surgical wards,and the difference was statistically significant(P<0.05).Amphotericin B and flucytosine were sensitive to all strains,and azole antifungals were less sensitive to non-Candida albicans.Among them,Candida parapsilosis and Candida tropicalis were more resistant to surgical wards and ICU,and the difference was statistically significant(P<0.05).Conclusion The main strains of fungal urinary tract infections in internal medicine and surgical wards were different.Candida albicans was mainly found in internal medicine wards,and Candida tropicalis is mainly found in surgical wards.Candida tropicalis was the least sensitive to azoles,and its resistance to fluconazole and voriconazole was more serious in surgical wards and ICU.Clinically,fluconazole could be the first choice for empirical treatment in internal medicine.For surgical ward and ICU,it is recommended that amphotericin B and(or)flucytosine should be considered as the first choice for treatment.