血液病房2010-2012年真菌培养阳性标本145例次临床分析

目的 探讨血液病房送检真菌病原学阳性的住院患者真菌感染的发生、临床特点及转归情况。方法 回顾性分析北京协和医院2010-2012年血液病房住院患者痰、血、拭子等各个部位标本真菌培养阳性者的临床资料，分析菌种分布、感染部位、致病真菌与定植真菌的区别。结果 送检病原学的真菌检出145例次，其中酵母菌78例(53.8%)，霉菌61例(42.1%)。在真菌培养阳性标本中，致病菌67例次(46.2%)，其中霉菌占致病菌的85.1%；定植菌78例次(53.8%)，其中酵母菌占93.6%。常见的病原检出部位依次为痰、上呼吸道、外周血，分别占77.2%、8.3%、4.1%。无菌部位阳性真菌均为致病菌，而非无菌部位中，下呼吸道致病菌检出率最高(47.3%)。在所有非无菌部位中，烟曲霉菌作为致病菌的几率要显著高于定植菌，而白色念珠菌多为定植菌(P均<0.05)。在真菌阳性的感染患者中，急性白血病占35.8%、血液肿瘤进展占32.8%。本研究中45例(67.2%)真菌感染患者经目标治疗好转，22例死亡。死亡患者中16例(72.7%)为霉菌感染。结论 我院血液科住院患者真菌检出以酵母菌和曲霉菌为主，但主要致病菌是曲霉菌，主要定植菌为酵母菌。在非无菌部位中，下呼吸道致病菌检出率最高，菌种为曲霉菌多为致病菌，而酵母菌多为定植菌。真菌感染的死亡患者以曲霉菌感染为主。

A clinical retrospective analysis of 145 positive fungal cultures in an open hematology ward from 2010 to 2012

Abstract：Objective To investigate the incidence，clinical features，and outcomes of hematologic hospitalized patients fungal infection.Methods We retrospectively collected the clinical data of the inpatients with positive fungal cultures in a hematology ward of Peking Union Medical College Hospital from 2010 to 2012 and analyzed the distribution of the fungal pathogen，the infection sites and the differences between the pathogenic and the colonized specimens.Results The fungi detection rate was 1.57% with totally 145 isolated specimens.The percentage of yeasts and molds were 53.8% and 42.1%，respectively.The main fungal types included Candida albicans and Aspergillus fumigatus.The pathogenic specimens and the colonized specimens accounted for 46.2% and 53.8% respectively.Among the pathogenic species，molds accounted for 85.1%，while in the colonized species yeasts reached 93.6%.Positive fungi were most found in the lower respiratory tract (77.2%)，followed by the upper respiratory tract (8.3%) and peripheral blood (4.1%).The positive isolates from aseptic sites were all pathogenic species.In non-aseptic site，the detection rate from sputum was 47.3%，and the probability of Aspergillus fumigatus being pathogenic was significantly higher than that being colonized，however，the Candida albicans were just the opposite，most of which were colonized (P<0.05).Among all the invasive fungal disease，67.2% patients turned better，and 32.8% ended up with death.The mycotic infection was more frequent (72.7%) in the fatal cases.Conclusion Yeasts and molds take the most proportion of the detected fungi in our hospital.The major pathogenic isolates are molds and the main colonized species are yeasts.The detection rate for pathogenic species from sputum was the highest among all the non-aseptic sites.Aspergillus fumigatus detected from the non-aseptic sites are pathogenic mostly while Candida albicans are colonized otherwise.Aspergillus infection is the main cause of deaths.