我院ICU 5年住院危重患者念珠菌感染状况分析

目的：掌握我医院重症监护室(ICU)5年的念珠菌感染状况。方法检测2009年1月至2013年12月期间我院ICU 3862例入住患者的血液、痰液、尿液等标本中的念珠菌，分析患者的念珠菌感染状况、感染标本来源、菌种分布及耐药性情况。结果近5年ICU患者的念珠菌感染率为1.71%(66/3862)，且呈逐年增加的趋势。感染标本主要来自痰液(65.2%)，其次是血液(13.6%)、尿液(9.1%)、粪便(6.1%)等。菌属分布主要为白色念珠菌(48.5%)，其次是光滑念珠菌(18.2%)、热带念珠菌(13.6%)、克柔念珠菌(9.1%)、近平念珠菌(7.6%)以及葡萄牙念珠菌(3.0%)，并且非白色念珠菌所占的比例呈现逐年上升的趋势。念珠菌对伊曲康唑的耐药率(12.1%)最高，其次是氟康唑(9.1%)、伏立康唑(7.6%)、卡泊芬净(6.1%)以及氟胞嘧啶(3.0%)。光滑念珠菌对伊曲康唑、氟康唑和伏立康唑的耐药率较高，克柔念珠菌对伊曲康唑和氟康唑的耐药率较高，近平念珠菌对伏立康唑和卡泊芬净的耐药率较高。结论近5年我院ICU患者的念珠菌感染率呈逐年增多趋势，感染部位主要集中在呼吸道，以白色念珠菌最常见，但非白色念珠菌所占的比例则呈现逐年上升的趋势，且耐药情况更严重，总体来看对伊曲康唑的耐药率最高。

Study on Candida infections in critically ill patients at ICU in the recent 5 years

Objective To investigate Candida infection at the intensive care unit (ICU) in our hospital in the re-cent 5 years. Methods Candida in all blood, sputum, urine of 3 862 patients, who admitted to ICU of our hospital from January 2009 to December 2013, were detected. Candida infection status, source distribution of Candida infection speci-men, distribution of Candida species, drug resistance of patients were analyzed. Results The rate of Candida infection was 1.71% (66/3 862) at ICU in the recent 5 years, and it showed an upward trend. Candida infection specimen were mainly from sputum (65.2%), followed by blood (13.6%), urine (9.1%), feces (6.1%). The major Candida species was Candida albicans (48.5%), followed by Candida glabrata (18.2%), Candida tropicalis (13.6%), Candida krusei (9.1%), Candida parapsilosis (7.6%) and Portugal Candida (3.0%). Proportion of non-Candida albicans showed a rising trend year by year. The highest rate of resistance was to itraconazole (12.1%), followed by fluconazole (9.1%), voriconazole (7.6%), casofungin (6.1%) and flucytosine (3.0%). There were greater resistance rates of Candida glabrata to itracon-azole, fluconazole and voriconazole. There were higher resistance rates of Candida krusei to itraconazole, fluconazole. There were higher resistance rates of Candida parapsilosis to voriconazole, casofunginwere. Conclusion The rate of Candida infection at ICU showed an upward trend in the latest 5 years. Candida infection mainly concentrated in the re-spiratory tract, which mainly caused by Candida albicans. Proportion of non-Candida albicans, whose drug resistance was more serious, increased annually. The highest rate of resistance was to itraconazole.