758株条件致病性真菌的临床分布及耐药性分析

摘要:目的　研究本院临床条件致病性真菌感染的分布特点、实验室诊断及耐药性情况，为临床诊断真菌感染及合理使用药物提供依据。方法　对2013年1月-2014年1月间各病区送检标本中鉴定出的758株条件致病性真菌的分类、药敏和（1，3）-β-D葡聚糖检测（G试验）情况进行回顾性分析。结果　分离出的条件致病性真菌主要来自病人的痰液标本、血液标本、体液及脓液等，其中白色假丝酵母菌562株（74.14%），近平滑假丝酵母菌88株（11.61%），光滑假丝酵母菌49株（6.46%），热带假丝酵母菌38株（5.01%），新型隐球菌13株（1.72%）和其他假丝酵母菌8株（1.06%）。白色假丝酵母菌、近平滑假丝酵母菌、皱褶假丝酵母菌和新型隐球菌对氟胞嘧啶、两性霉素B、氟康唑及伏立康唑耐药率较低（＜10%），对伊曲康唑耐药率较高（＞10%）；光滑假丝酵母菌、热带假丝酵母菌和克柔假丝酵母菌对氟康唑、伏立康唑及伊曲康唑耐药率较高（＞10%）。对164例高度疑似系统性真菌感染或真菌菌血症患者同时进行真菌培养和G试验，阳性率分别为60.37%和76.83%。结论 假丝酵母菌感染主要以呼吸道、消化道和泌尿道感染为主，不同类型的假丝酵母菌对药物的敏感性有所不同，因此快速而准确地鉴定及药敏试验对临床及时诊断和治疗假丝酵母菌感染有着重要的意义。

The clinical distribution,laboratory diagnosis and drug resistance in 758 cases of conditional pathogenic fungal infections

Abstract: Objective To study the clinical distribution, laboratory diagnosis and drug resistance situation of conditional pathogenic fungal infections of our hospital, so as to provide basis for the guidance of clinical diagnosis and rational use of drugs. Methods We analyzed the classification, drug sensitivity and 1, 3-beta-D-glucan assay (G test) situation of 758 cases of conditional pathogenic fungal which came from each ward specimens in our hospital from January 2013 to January 2014. Results The conditional pathogenic fungal was isolated mainly from the patient, including sputum, blood, body fluid and pus etc. The strains of Candida albicans, Candida parapsilosis, Candida glabrata, Candida tropicalis, Cryptococcus neoformans and others were 562 (74.14%), 88 (11.61%), 49 (6.46%), 38 (5.01%), 13 (1.72%) and 8 (1.06%), respectively. The drug resistance rates of Candida albicans, Candida parapsilosis, folds of Candida and Cryptococcus neoformans to flucytosine, amphotericin B, fluconazole and voriconazole were low (<10%), but higher resistance rate for itraconazole (>10%). The drug resistance rates of Candida glabrata, Candida tropicalis and Candida krusei to Fluconazole and itraconazole, voriconazole were high (>10%). Fungal culture and G test were done at the same time in 164 cases which were highly suspected as systemic fungal infection or fungal septicemia, with positive rates being 60.37% and 76.83%, respectively. Conclusion The Candida infection was mainly in respiratory tract, digestive tract and urinary tract. The drug sensitivities of Candida albicans in different regions, different types were different. Hence, the rapid and accurate identification and drug sensitivity test play an important role in clinical diagnosis and treatments.