住院患者真菌感染的现况调查及病原学分析

目的　了解住院患者真菌感染的临床特点、发病率和疾病谱，为减少真菌感染提供依据。方法2006年1 - 12月间住院患者真菌培养阳性的病例，从患者年龄、疾病种类、标本、菌种分布、科室等方面进行分析。结果　住院患者真菌感染的发病率为5.07%，年龄分布在7 ～ 96岁之间，多为60岁以上患有基础疾病的老年人；感染部位以下呼吸道为最多；感染真菌主要为念珠菌属（93.68%），且以白念珠菌居多；所有患者均使用过2种或2种以上抗细菌药物。住院患者真菌感染的发生与多种广谱抗生素的使用、糖皮质激素或免疫抑制剂治疗、气管切开或插管、年龄≥60岁、留置导尿、恶性肿瘤性疾病等有关。结论　白念珠菌仍是住院患者真菌感染的主要病原菌。合理使用药物、减少侵入性治疗、提高机体免疫力是预防侵袭性真菌感染及改善预后的重要手段。

Clinical and pathogenic analysis of nosocomial fungal infection

Objective To investigate the clinical and pathogenic features of nosocomial fungal infections. Methods A prospective study was performed. Fungal culture was carried out with various samples, such as urine, sputum, blood, discharge, etc, from inpatients during 2006. For patients with positive culture, questionnaires were designed to collect data on their age, disease profile, sample resources, fungal species distribution. Results A total of 918 strains of fungus were isolated from 3 698 inpatients. The incidence of nosocomial fungal infections was 5.07%. The patients with fungal infection aged from 7 to 96 years, and most of them were older than 60 years with various underlying diseases. Lower respiratory tract was the most frequent infection site. Candida spp. acounted for 93.68% among all pathogens, and Candida albicans for 65.69%. Two or more antibiotics were administed in all the patients. The occurrence of nosocomial fungal infections was closely related to the application of multiple broad-spectrum antimicrobial agents, corticosteroids, immunosuppressive agents, endotracheal intubation or tracheotomy, advanced age （≥60 years）, malignancy, and indwelling urethral catheter. Conclusions Candida albicans is the primary pathogen of nosocomial fungal infections. Rational use of antimicrobial agents, judicial decrease of invasive treatment, and enhancement of immunity may be the most important measure for the prevention of nosocomial invasive fungal infections, and improvement of prognosis.