重症监护病房深部真菌感染回顾性分析

目的分析重症监护病房(ICU)患者深部真菌感染的常见菌种、好发部位及耐药性,并探讨其危险因素。方法2006年1月-2007年3月入住ICU患者所送的各类感染标本进行真菌培养分离菌株,鉴定采用API 20CAUX,Rosco纸片扩散法测定药敏性。结果共检出真菌123株,以白色假丝酵母菌检出率最高(34.1%),其次为光滑假丝酵母菌(26.8%)、热带假丝酵母菌(18.7%);所有分离的菌株对两性霉素B、制霉菌素敏感,对氟康唑、伊曲康唑及酮康唑部分耐药;长期使用广谱抗菌药物、留置导管、老年患者诱发真菌感染率高。结论假丝酵母菌属是ICU院内获得性真菌感染的主要病原菌;感染的主要部位在下呼吸道;两性霉素B、制霉菌素敏感性仍较好,但其毒性较大;三唑类药物对白色假丝酵母菌及热带假丝酵母菌也有较高的敏感性,但光滑假丝酵母菌、克柔假丝酵母菌对三唑类药物具有较高的耐药率;合理使用抗菌药物,减少不必要的诊疗操作,早发现、早诊断、早治疗是防治深部真菌感染的关键。

Invasive Fungal Infection in ICU:A Retrospective Analysis

OBJECTIVE To have an retrospective analysis of the prevalent fungi infected in patients in ICU,and their pathologic sites and drug resistance and to find out the hazard factors.METHODS The research used API 20C AUX and Rosco disk diffusion method to test the drug resistance of fungi isolated from the infected samples collected from ICU patients in our hospital between Jan 2006 and Mar 2007.RESULTS Totally 123 fungi strains were spotted,the majority of them being Candida albicans,accounting for 34.1%;Candida glabrata 26.8% and Candida tropicalis 18.7%.All the fungi were sensitive to amphotericin B and nystatin(Mycostatin) and partially resistant to fluconazole,itraconazole and ketoconazole.Patients with long term use of wide-spectrum antibiotics and catheters and elder patients would have higher fungi infection rate.CONCLUSIONS Candida are the major pathogens of fungal infections in ICU.The major infected site is lower respiratory tract.Amphotericin B and nystatin have good sensitivity but higher toxicity.Conazole medicines also have good sensitivity to C.albicans and C.tropicalis.But they are resisted largely by C.glabrata and C.krusei.Reasonable use of bacteriophage and reduction of unnecessary diagnosis and treatment procedures,and early discovery,diagnosis and treatment are keys to prevent and cure the invasive fungal infections.