住院患者真菌耐药性调查与抗菌药使用分析

目的:探讨住院患者真菌感染临床特点、抗菌药使用情况,真菌感染的诱发因素,寻找遏制方法和措施。方法:采用回顾性调查,分别对2003年1月-2004年6月期间住院患者中的真菌感染病例以及该患者所用抗菌药品种和数量进行统计分析。结果:发现真菌感染病例301例次,均为念珠菌属,涉及126份病历,共检出真菌7种301株,其中白色念珠菌最多,197株(65．45％)。痰标本的检出率最高,214株(71．10％)。有123人(97．62％)使用抗菌药,平均使用3．91种抗菌药,最多使用16种,最长使用109 d,113人(91．87％)使用超过7 d。体外抗真菌药物敏感性试验结果显示,特比奈酚的耐药率最高86．05％,氟康唑和酮康唑的耐药率分别为8．31％和13．62％。结论:医院内真菌感染耐药性非常普遍,长时间、大剂量使用广谱抗菌药是造成院内真菌感染及耐药的重要的原因之一。

Analysis of Fungal Infection, Antibiotics Usage and Tolerance of Inpatients

Objective: To investigate the state of nosocomial fungal infection of the inpatients and its clinical behavior and the usage of the antibiotics. To discuss the inducing factors of the nosocomial fungal infection and find the measures to keep them within limits. Method: The fungal infection cases of the inpatients of our hospital admitted from 2003-01-01 to 2004-06-30 were studied retrospectively. The kinds and quantity of the antibiotic used were analyzed statistically. Result: 301 fungal infection cases were found and related to 126 patients. 7 species and 301 plants had been detected. The most plants among them was the Candida albicans ,which were 197(65.45% ). The most frequency of detection was the sputum specimen with 214(71.10% ). 123 patients(97.62% ) took the antibiotic. 3.91 kinds of antibiotics were taken at average with individual even as high as 16 kinds. 113 patients(91.87% ) took the drug more than 7 days, the longest one was 109 days. The result of the anti - fungal sensibility test in vitro showed that the highest tolerance rate was the Terbinafine (86.05% ). The tolerance rate of the Fluconazol and Ketoconazole were 8.31% and 13.62% respectively. Conclusion: The Phenomenon of anti -fungal tolerance is widely in nosocomial fungal infection. long time and large dosage using of the broad-spectrum antibiotics is the main cause of drug lolerance.