酵母菌医院感染的危险因素与耐药性分析

目的了解酵母菌医院感染的危险因素与耐药现状。方法住院患者各类感染标本中分离出的酵母菌286株采用全自动微生物鉴定仪及YBC卡鉴定。氟康唑（FCZ）的药敏试验采用酵母菌琼脂扩散法，其余6种药物采用ATB Fungus药敏试剂盒，分别测定7种常用抗真菌药物对286株酵母菌的药敏结果。结果白色假丝酵母菌检出率最高(占67.8%)，其次为热带假丝酵母菌（17.5%）、光滑假丝酵母菌（8.4%）。医院酵母菌感染危险因素为严重的相关基础疾病、住院时间长、患者老龄化、糖皮质激素和免疫抑制药的应用等。酵母菌对两性霉素B、氟康唑、制霉菌素、5-氟胞嘧啶的敏感率分别为97.9%，90.9%，89.5%，88.8%，对咪康唑、酮康唑、益康唑耐药率分别为12.2%，17.5%，30.8%。结论医院酵母菌感染及耐药性呈上升趋势。加强酵母菌的耐药监测，为防止酵母菌院内感染及抗真菌药物合理使用提供理论依据。

Risk Factors and the Resistance of Nosocomial Infection Caused by Yeasts

Objective To investigate the risk factors and current status of resistant hospital acquired infection of yeasts. Methods The total 286 clinical isolates of yeasts were collected and identified with automatic microorganism identification instrument and YBC card. Susceptibility test of fluconazole was performed using a yeast disk diffudion test. For the other six drugs, ATB fungus susceptibility reagent box was adopted to determine the results of susceptibility test of 7 commonly used anti-fungus agents to 286 isolates of yeasts. Results The Strains of Candida albicans had the highst detection rate, accounting for 67.8% of all the isolates. C. tropicalis, C. glabrata accounted for 17.5% ,8.4% respectively. The risk factors of nosocomial infection caused by yeasts could attribute to multiple factors, such as correlated serious original diseases,long course of hospitalization,aging, applications of adrenocortical steroid and immunosuppressant, etc. The rates of susceptibility of yeasts to amphotericin B,fluconazole, nystatin and flucytodine were 97.9% ,90.9%, 89.5% and 88.8%, respectively. The rates of resistance to miconazole, ketoconazole and econazole werel2.2%, 17.5% and 30.8%, respectively. Conclusion Hospital acquired infection of yeasts and resistance show an increasing tendency. Enhancing the resistance monitoring of yeasts could provide scientific basis for rational use of medication against fungus and prevention of nosocomial infection of yeasts.