真菌性角膜炎病原菌分布及药物敏感性结果分析

Analysis of pathogenic bacteria distribution and drug sensitivity results of fungal keratitis

目的了解我院真菌性角膜炎的病原菌分布情况及其药物敏感性结果,旨在为临床抗真菌药物的选择提供参考。方法采用回顾性病例分析法,收集本院2020年1月至12月角膜炎病变累及部位真菌培养阳性标本86例(来自74例患者),对其病原菌分布和药物敏感性结果进行汇总。结果86例真菌培养阳性标本中,男性患者标本58例,女性患者标本28例,患者的中位年龄为55岁。病变角膜是进行真菌培养的主要取材部位,且培养阳性率高达77.91%。真菌培养阳性率排名前三位的为镰刀菌属、链格孢属和曲霉菌属,且出现1例少见的淡紫紫孢菌。大多数真菌病原菌对伏立康唑敏感。抗真菌药物敏感性结果显示,伏立康唑的敏感率最高,达93.02%;其次为那他霉素,为61.63%;特比奈芬的敏感率为25.58%。氟康唑的耐药率最高,达91.86%;其次为两性霉素,为81.40%;伏立康唑的耐药率最低,为6.98%。结论真菌性角膜炎的最常见病原菌包括镰刀菌属和链格孢属;伏立康唑的药物敏感性最高,其次为那他霉素;氟康唑和两性霉素耐药率较高。在培养结果未出来前,临床医师应经验性使用广谱敏感抗真菌药物,待培养结果出来后应根据药物敏感性结果调整用药。

Objective To understand the pathogenic bacteria distribution and drug sensitivity results of fungal keratitis in our hospital,in order to provide references for the selection of clinical antifungal drugs.Methods A retrospective case analysis method was used to collect 86 positive fungal culture samples(from 74 patients)from keratitis lesion involved sites in our hospital from January to December 2020,and the pathogenic bacteria distribution and drug sensitivity results were summarized.Results Among the 86 positive fungal culture samples,58 were male and 28 were female.The median age of the patients was 55 years old.Diseased cornea was the main sampling site for fungal culture,and the positive rate of culture was 77.91%.The top three positive rates of fungal culture were Fusarium,Alternaria and Aspergillus,and there was one rare case of Purpureocillium lilacinum.Most fungal pathogenic bacteria are sensitive to voriconazole.The results of antifungal drug sensitivity showed that voriconazole had the highest sensitivity rate,reaching 93.02%;the second was natamycin,accounting for 61.63%;the sensitivity rate of terbinafine was 25.58%.The drug resistance rate of fluconazole was the highest,reaching 91.86%;the second is amphotericin,accounting for 81.40%;the drug resistance rate of voriconazole was the lowest,accounting for 6.98%.Conclusion The most common pathogenic bacteria of fungal keratitis include Fusarium and Alternaria;voriconazole has the highest drug sensitivity,followed by natamycin;the resistance rate of fluconazole and amphotericin was high.Before the culture results are available,clinicians should empirically use broad-spectrum sensitive antifungal drugs,and the drugs should be adjusted according to the drug sensitivity results when the culture results are available.