普外科非白色念珠菌感染诊治

目的普通外科深部非白色念珠菌感染的发生的病原真菌的种类,易患因素、耐药情况及防治。方法回顾性分析2004年3月—2008年6月间郑州大学第一附属医院普通外科收治的31例非白色念珠菌病人的易感因素、病原学种类特点、耐药情况及治疗措施。结果易感因素主要为使用广谱抗生素、中心静脉插管、全胃肠外营养、高龄、大型手术、入住重症监护病房等。31例病人分离出40例菌株,同一患者可培养出不同菌株。非白色念珠菌的主要致病真菌是热带念珠菌、葡萄牙念珠菌、克柔念珠菌、光滑念珠菌,大部分对氟康唑耐药。31例经抗真菌治疗者中8例死亡,病死率25.81%。结论非白念感染感染多发生多存在宿主因素,菌株以热带念珠菌、葡萄牙念珠菌为主,大部分对氟康唑耐药,部分对伊曲康唑耐药。对高危病人应重视病原学检查及药物敏感性测定,消除易感因素,及时合理选用抗真菌药物和加强支持治疗,有望进一步改善预后。

Diagnosis and Treatment of Mon-albicans Candida Infection at General Surgery Department

Objective To investigate the fungus species,predisposing factors,drug resistance,prevention and cure of Non-albicans Candida at general surgical department.Methods The data of 31 Non-albicans Candida-infected patients from the Frist Affiliated Hospital of Zhengzhou University from Mar.2004-June 2008,were studied retrospectively.The predisposing factors,pathogenic characteristics,drug resistance and corresponding treatments were analyzed.Results The predisposing factors are mainly associated with the application of broad-spectrum antibiotic,central vein cannula,total parenteral alimentation,senility,big operations,ICU,etc.40 strains of Non-albicans Candida were identified from 31 patients.Different stains were isolated from the same patient.Main pathomycetes were Candida tropicalis,Candida lusitaniae,Candida krusei and Candida glabrata.Most of them were resistant to Fluconazol.Among 31 patients received antifungal treatments,8 patients died.The case fatality was up to 25.81%.Conclusion Non-albicans Candida infection was closely related to the host.Main pathomycetes were Candida tropicalis and Candida lusitaniae.Most of them were resistant to Fluconazol;Part of them were resistant to Itraconazol.To improve the prognosis of the high risk patients,it was very impormant to do pathogen examination and drug sensitivity examination,and it was necesssary to eliminate the predisposing factors,select the reasonable medicine in time and strengthen the supportive treatment.