重症监护病房患者深部真菌感染分析

目的探讨笔者所在医院重症监护病房（ICU）患者深部真菌感染的发病特点，并了解院内深部真菌感染常见致病菌的耐药情况。初步探讨院内深部真菌感染高危因素，对相关因素进行分析，为有效控制真菌感染及合理用药提供参考依据。方法采用前瞻性对照研究，对2011年1月～2012年6月入住ICU经筛选符合条件的231例患者作为研究对象，随访和调查患者的性别、年龄、住院时间、基础疾病，是否有侵入性操作、使用抗真菌药物情况，以及部分血生化检查指标，同时记录真菌感染者致病菌种及药敏试验结果。结果231例患者中真菌感染者37例，深部真菌的发病率为16．02％。真菌感染部位以下呼吸道感染最为常见。从血液、尿液、痰液、胸腔积液、腹水、脑脊液等标本中共分离出菌株45株，其中酵母菌42株，霉菌3株，酵母菌中以白念珠菌（18株）最为多见。真菌培养药敏试验结果显示抗真菌药物对深部真菌的敏感性分布有明显的种问差异。结论①深部真菌感染以白念珠菌最为常见，其次是热带念珠菌、光滑念珠菌、曲霉。真菌感染部位以下呼吸道感染最为常见。药敏试验结果显示，抗真菌药物对深部真菌的敏感性分布有明显的种间差异。②高龄、住院时间长、抗菌药物的广泛应用、各种侵入性操作的使用、高血糖、低蛋白血症、贫血是ICU患者深部真菌感染的高危因素。

Analysis of deep fungal infection in intensive care units

Objective To investigate the incidence feature and the common pathogens of deep fimgal infection in the intensive care units of the authors＇ hospital, and to learn about the resistance status of the pathogens. To investigate the risk factors of deep fungal infection, then analysis the relevant factors, to provide the reference for deep fungal infection control and antifungal drugs rational use. Methods It was a prospective case-control study. The objects of the study were 231 ICU patients who were screened and meet the demand from Jan 2011 to Jun 2012. Reviewed the patients according to the agreed questionnaire since they were admitted. The contents were as follows： sex, age, length of stay, underlying disease, whether accepted invading medical operation or not, the use of antimicrobial antifungal treatment, and some biochemical indicator. Fungal category of the pathogens and drug sensitive test results were recorded in the infection group. Results In the total 231 patients, there were 37 patients developed into deep fungal infection, the incidence is 16.02%. The most common infection site was lower respiratory tract. A total of forty five strains were totally separated from the blood, urine, sputum, hydrothorax, ascites and CSF sample, including 42 strains of yeast, 3 strains of mould. Candida albicans（18 strains） was the commonest in the yeast. There was significant difference of the anti-fungal drugs susceptibility among the species. Conclusions The most common pathogen was candida albicans, the following was C tropicalis, C glabrata and aspergillus. Respiratory tract was the most common infection site. There was significant difference of the anti-fungal drugs susceptibility among the species. The risk factors were as follows： old age, longer duration of admitted in ICU, severity of diseases, usage of broad-spectrum antibiotics, invading medical operation, hypoalbuminemia, hyperglycemia and anemia.