2014-2018年ICU真菌血症病原菌分布及抗菌药物敏感性分析

目的:研究我院ICU科室真菌血症病原菌的分布特点和药敏结果，为真菌血症的临床诊断和抗菌药物治疗提供依据。方法:对我院2014-2018年，5年间ICU科室血培养分离酵母样真菌且符合真菌血症诊断标准的临床资料进行回顾性分析，应用WHONET 5.6软件对菌株分布和药敏结果进行统计。结果:ICU确诊真菌血症患者共129例，致病菌主要为近平滑念珠菌（59株，45.7%）、白色念珠菌（22株，17.1%）、光滑念珠菌（14株，10.9%）和热带念珠菌（12株，9.3%）。真菌血症以男性患者（72.1%）居多，好发于65岁及以上老年（64.3%）；重症医学科（55.8%）和老年病房ICU（20.2%）分离率较高。所有菌株对5-氟胞嘧啶和两性霉素B敏感性较高，对唑类药物出现不同程度耐药。结论:我院真菌血流感染以近平滑念珠菌为多见。光滑念珠菌、热带念珠菌、红酵母属对唑类药物的敏感性相对较低。推广质谱、分子生物学等快速鉴定技术，了解真菌血症病原菌对抗菌药物的敏感性，对ICU真菌血流感染患者的早期诊治和预后有着重要意义。

Analysis of distribution and antimicrobial sensitivity of fungemia pathogen in intensive care units from 2014 to 2018

Objective: To analysis the distribution characteristics and antimicrobial sensitivity of pathogenic fungus from blood culture in ICU departments, and to provide the basis for clinical diagnosis and antibiotic treatment of fungemia. Methods: The clinical data of yeast-like fungi isolated from blood culture and met the diagnostic criteria of fungemia from 2014 to 2018 were retrospectively analyzed. The distribution and antimicrobial sensitivity results were statistically analyzed by WHONET 5.6 software. Results: A total of 129 patients in ICU departments were diagnosed with fungemia. The main pathogenic fungus in ICU were Candida parapsilosis (59 strains, 45.7%), Candida albicans (22 strains, 17.1%), Candida glabrata (14 strains, 10.9%) and Candida tropical (12 strains, 9.3%). The majority of patients are male（72.1%）and aged ＞65 (64.3%). The departments with high isolating rate were critical care medicine （64.3%）and gerontological ward ICU（20.2%）. All strains were highly sensitive to 5-Flucytosine and Amphotericin B, and presented varying degrees of resistance to azole drugs. Conclusion: Candida parapsilosis is the most common pathogen of fungemia in our hospital. The sensitivity rates of Candida glabrata, Candida tropical and Rhodotorula to azole drugs were relatively low. To popularize rapid identification techniques such as mass spectrometry, and to analyze the sensitivity of antifungal drugs are of great significance in early diagnosis, treatment and prognosis of patients with fungal bloodstream infection in ICU.