811例酵母样真菌感染的临床分布及药敏分析

目的分析临床酵母样真菌感染的分布情况,结合真菌的鉴定及药敏,指导临床合理用药。方法回顾性分析真菌感染者的临床资料、检出的酵母样真菌的分布及对抗真菌药物的耐药特点。结果真菌感染以60岁以上老年人居多,占69.4%,感染部位主要为呼吸道、泌尿道及肠道;基本都有抗生素使用史,多有创伤性介入治疗。检出真菌主要为白色假丝酵母菌,共526例,另有热带假丝酵母菌117例,光滑假丝酵母菌86例,近平滑假丝酵母菌57例,其他酵母菌25例。10种抗真菌药物中,耐药性较高的为特比奈芬、制霉菌素和两性霉素B,比较敏感的为5-氟胞嘧啶和酮康唑。两性霉素B33.9%和氟康唑22.6%的耐药率,大大高于以往熟知的程度,这与临床大量常规使用其预防真菌感染有密切联系。结论应加强真菌检测,指导临床合理使用抗生素,减少多重耐药出现。

Clinical distributions of 811 cases of yeast-like fungal infections and their drug susceptibility

Objective The distributions of the detected yeast-like fungi in clinical cases were analyzed.Instructions for rational use of drug were provided according to Fungus＇s appraisal and the medicine sensitivity.Methods The clinical data of the candidate infected patients as well as the distribution of the detected yeast-like fungi and the characteristics of the antifungal drug resistance were retrospectively analyzed.Results Most of fungal infected candidates are over sixty year old people,which accounts for 69.4%.The infections occurred mainly at respiratory tract,urinary tract and intestinal tract.These patients have the basic history of antibiotic use in the cases of invasive interventions.In all the 811 Fungi that were detected,Candida albicans,Candida tropicalis,Candida smooth and Candida parapsilosis dominate in 526 cases,117 cases,86 cases and 57 cases,respectively.Only 25 cases of other yeast were claimed.For all the ten kinds of antifungal drugs,Nystatin and Amphotericin B show a higher terbinafine resistance than those of 5-Fluorocytosine and Ketoconazole,which were also sensitive.Moreover,Amphotericin B 33.9% and Fluconazole 22.6% showed much higher resistance rates than the previous known levels,which were closely related to the fact that it was routine clinically used to prevent fungal infections.Conclusion Fungal testing should be strengthened.Guidelines for the rational use of antibiotics were provided.The emergence of multiple drug resistance should be reduced.