临床真菌血流感染的菌株分布及耐药性分析

目的 分析临床真菌血流感染的病原菌分布及耐药特征,为真菌血流感染的诊治提供理论依据。方法 回顾性分析2015年1月～2017年12月临床真菌血流感染的菌株分布及药敏试验结果。结果 共分离264例真菌。近平滑念珠菌检出率最高(53.79%),其次是角膜假丝酵母(13.63%)和白念珠菌(7.58%)。检出念珠菌数前三位科室依次为普外科(32.58%)、心血管外科(21.59%)和胸外科(8.33%)。对氟康唑、伊曲康唑和伏立康唑的敏感率,白念珠菌均为100%; 近平滑念珠菌分别为100%,99.3%和100%; 角膜假丝酵母分别为94.4%,19.4%和97.2%。对于5-氟胞嘧啶,白念珠菌敏感率100%,近平滑念珠菌和角膜假丝酵母的敏感率仅为70.4%和11.1%。三者对两性霉素B的敏感率≥95%。结论 近平滑念珠菌是该院临床血流感染最常见的真菌,绝大部分念珠菌对抗真菌药物的敏感率较高。要高度重视病原学监测,规范临床抗真菌药物的合理应用。

Pathogen Distribution and Drug Resistance Analysisof Clinical Fungal Bloodstream Infection

Abstract:Objective To investigate the pathogen distribution and drug susceptibility profile of fungal isolates from bloodstream infections,and provide the basis for clinical diagnosis and treatment.Methods A retrospective analysis was carried out to analysis the fungal pathogens isolated from bloodstream infections in Changhai Hospital during the period from January 2015 to December 2017.Pathogen distribution and antibioticresistance for the fungal infections were analyzed.Results A total of 264 fungal strains were isolated.There were 142 Candida parapsilosis(53.79%),36 Candida pelliculosa(13.63%)and 20 Candida albicans(7.58%).These patients mainly came from the department of general surgery(32.58%),cardiovascular surgery(21.59%)and thoracic surgery(8.33%).Drugsensitive test showed that sensitivity of Candida parapsilosis to fluconazole,itraconazole and voriconazole were 100%,99.3% and 100%,whereas Candida pelliculosa were 94.4%,19.4% and 97.2%,respectively.Candida albicansisolates were 100% susceptible to all the azole antifungal drugs.The sensitivity of Candida albicans,Candida parapsilosis,and Candida pelliculosa to5-fluorocytosine were 100%,70.4% and 11.1%,respectively.The susceptible rate of all strains to Amphotericin B were high.Conclusion The main pathogen of fungemia was Candida parapsilosis.Most of the candidas were susceptible to antifungal drugs.Intensifying the pathogen surveillance,making an early diagnosis and early experience antifungal therapy are moreimportant to reduce the mortality of fungal infection.