2014—2017年解放军总医院海南分院真菌分布及耐药性分析

目的 了解2014—2017年解放军总医院海南分院真菌的分布和耐药特点，为促进抗真菌药的合理应用、有效减缓真菌耐药提供参考。方法 提取解放军总医院海南分院2014年1月—2017年12月临床真菌分离和药敏相关数据，分析真菌的分布特征及其对常用抗真菌药的耐药率和变化趋势。结果 共纳入1 048份阳性真菌样本，呼吸道标本占41.89%，60岁以上患者（61.45%）和重症医学科（25.48%）分布比例最高；共分离出1 329株真菌，白色念珠菌、念珠菌属、热带念珠菌分别占24.53%、15.80%、13.69%。各种念珠菌对两性霉素B和5-氟胞嘧啶的敏感率基本保持在90%以上；热带念珠菌对伊曲康唑耐药率最高，达10%～20%，对氟康唑和伏立康唑的耐药率亦高于两性霉素B和5-氟胞嘧啶；白色念珠菌对伊曲康唑和伏立康唑的耐药率呈逐年快速上升趋势。结论 白色念珠菌和热带念珠菌感染应慎用唑类抗真菌药；两性霉素B和5-氟胞嘧啶是念珠菌感染的有效选择。

Analysis on distribution and drug resistance of fungal in Hainan branch of PLA General Hospital from 2014 to 2017

Objective To investigate the distribution and drug resistance of fungal in Hainan branch of PLA General Hospital from 2014 to 2017, and to provide reference for promoting the rational use of antifungal drugs and effectively alleviating fungal resistance. Methods According to the data on clinical isolates and drug susceptibility from January 2014 to December 2017 in Hainan branch of PLA General Hospital, the distribution characteristics and the resistance profile of fungi were analyzed, as well as the trend. Results Among the 1 048 samples of culture-positive fungal, most of them were isolated from respiratory tract (41.89%). Patients over 60 years old (61.45%) and patients in ICU (25.48%) took the higher proportion. Among the 1 329 strains of fungal, Candida albicans, Candida spp, and C. tropicalis accounted for 24.53%, 15.80%, and 13.69%, respectively. The sensitive rate of various candida to amphotericin B and 5-fluorouracil remained above 90%. The resistance rate of C. tropicalis against itraconazole was the highest, up to 10% - 20%. And the resistant rate of C. tropicalis against fluconazole and voriconazole were higher than those of amphotericin B and 5-fluorouracil. And the resistant rate of C. albicans against itraconazole and voriconazole was increased rapidly year by year. Conclusion The pyrroles antifungal agents should be used with caution for the infection of C. albicans and C. Tropicalis. Amphotericin B and 5-fluorouracil are effective candidates for Candida species infections.