儿童真菌感染的病原学研究

目的探讨广州地区儿童真菌感染的病原分布特点及其耐药状况，为防治儿童真菌感染提供实验室依据。方法对患儿感染部位的真菌进行分离培养和鉴定：以ATB^TM FUNGUS3酵母样真菌药敏试验条进行常用抗真菌药物的敏感性分析。结果从患儿标本中分离出558株真菌，主要来自呼吸道有299株，占53．58％；其次是消化道、伤口（创口）、泌尿系统和血液等，分别占28．14％、6．27％、4．66％、3．76％。其中白色假丝酵母菌367株，占65．77％；其次为热带假丝酵母菌、光滑假丝酵母菌、近平滑假丝酵母菌、克柔假丝酵母菌、季也蒙假丝酵母菌等，分别占15．28％、5．02％、4．48％、3．41％、2．69％。从骨髓中检出5株马尔尼菲青霉，从脑脊液中检出3株新型隐球菌。真菌对两性霉素B、5-氟胞嘧啶、氟康唑、伊曲康唑、伏立康唑等总耐药率分别为8．78％、4．84％、10．54％、1．36％、0．85％。结论引起儿童真菌感染的主要病原菌是白色假丝酵母菌。对真菌感染应该有针对性地使用高效的抗真菌药物进行早期治疗。

Etiological Study of Fungal Infection in Pediatric Patients

Objective To investigate the characteristics of pathogen distribution and drug resistance in pediatric fungal infection. Methods The fungi were identified by VITEK2-Compact verification and the drug sensitive experiments were done by ATB^TM FUNGUS 3 trial. Results There were 558 fungal strains in all samples. The major infection site was respiratory tract （299 cases, 53.58%）; infection rates in intestinal tract, wound, urinary tract and blood were 28.14%, 6.27%, 4.66% and 3.76%, respectively. The most common infection pathogen was Candida albicans （ 367strains, 65.77% ）, infection rates with Candida tropicalis, Candida glabrata, Candida parapsilosis, Candida kruse and Candida guilliermondii were 15.28%, 5.02%, 4.48%, 3.41% and 2.69%, respectively. These anti-fungus medicine resistance of 558 fungal strains to amphotenicin B （AMB）, 5-flucytosine （SFC）, fluconazole （FCA）, itraconazole（IRT） and voriconazole （VRC） were 8.78%, 4.84%, 10.54%, 1.36% and 0.85%, respectively. Conclusion Candida albicans was the most important pathogen in pediatric fungal infection. The key of successful treatment was maintaining high alertness and identifying mycosis at an early stage.