重症监护病房获得性念珠菌感染的临床分布及耐药分析

目的对重症监护病房(ICU)院内念珠菌感染送检标本分离出的念珠菌,进行细菌分布及药敏结果分析,为临床用药提供依据.方法对我院ICU 2002年1月～2004年12月,181株念珠菌医院感染病例进行回顾性分析.结果ICU院内念珠菌感染老年患者居多;感染部位以泌尿道为主;基础疾病则为脑血管疾病的感染率最高;并与侵入性操作、抗菌药物和免疫抑制剂的使用、患者的机体免疫力有关;分离出的181株念珠菌中以热带念珠菌为多见,其次是白色念珠菌;药敏结果敏感率由高到低分别为:两性霉素B 96.1%、制霉菌素96.1%、5-氟胞嘧啶90.6%、酮康唑81.2%、咪康唑76.2%、益康唑75.1%、伊曲康唑75.0%、氟康唑64.9%.结论高龄、严重 基础疾病、侵入性操作、大量广谱抗菌药物的使用是ICU念珠菌感染的易感因素;ICU念珠菌感染以热带念珠菌最为多见,药物敏感性以两性霉素B、制霉菌素、5-氟胞嘧啶为高;对送检标本及时进行真菌培养和药敏试验,合理使用抗菌药物和抗真菌药,减少多重耐药和深部真菌感染的发生.

Nosocomially Acquired Candida spp Infection in ICU: Its Clinical Distribution and Drug Resistance

OBJECTIVE To investigate the distribution and antimicrobial susceptibility test results of isolated Candida spp from clinical samples in ICU,and provide useful information for the clinical treatment. METHODS Totally 181 strains nosocomially acquired Candida spp infection in ICU from Jan 2002 to Dec 2004 were analyzed. RESULTS The incidence of nosocomially acquired Candida spp infection of senile patients was high;the main nosocomially acquired Candida spp infection occurred in urinary tract;among basic diseases,the patients suffered cerebrovascular diseases were the most easily infected with these strains;the incidence was related to invasive operations,broad spectrum antibiotics abused,the patients immune system and the use of immunodepressants.Of the 181 isolates,Candida tropicalis was the most common species,followed by C.albicans.The susceptibility rate of drugs was as follows amphotericin B(96.1%),nystatin(96.1%),flucytosine(90.6%),ketoconazole(81.2%),miconazole(76.2%),econazole(75.1%),itrconazole(75%),and fluconazole(64.9%). CONCLUSIONS The advantage age,severe basic diseases,invasive operations and broad spectrum antibiotics abused are the risk factors,which make ICU patients easily to infect with Candida spp.The C.tropicalis infection is the most common among Candida infections.Susceptibility results show that Candida infections are susceptible to amphotericin B,nystatin and flucytosine;therefore,clinical physicians should initially carry out bacterial culture and antimicrobial susceptibility test so as to select appropriate antimicrobial or antifungal agents and minimize emergence of multiresistance and systemic fungal infection.