2012-2014年医院获得性深部真菌感染的临床分布及药敏结果

摘要:目的 对医院获得性深部真菌感染的临床分布及药敏结果进行分析，为临床医院感染防控及合理用药提供依据。方法 对2012年1月至2014年12月某三甲医院经实验室证实的深部真菌感染病例检出的真菌菌株信息、药敏结果以及相关临床信息进行收集、整理、分析。结果 共检出医院获得性深部真菌267株，来源于264例患者；患者年龄大于60岁占78.11%，死亡34例（病死率为12.88%）。标本来源以血标本（37.08%）与痰标本（34.83%）为主。病例来源前四位的科室为:重症医学科、急诊科、老年病房和血液内科。白色假丝酵母菌对各种抗真菌药物耐药率普遍要低，光滑假丝酵母菌与热带假丝酵母菌对三唑类抗真菌药物均耐药性较高。结论 重症医学科、急诊科、老年病房和血液内科是医院获得性深部真菌感染防控的重点科室。目前，真菌耐药的问题没有达到细菌耐药的严重程度，但非白色假丝酵母菌对抗真菌药物的耐药性，尤其是三唑类药物的耐药情况应引起足够关注。

Clinical distribution and drug sensitivity of hospital-acquired deep fungal infections between 2012 and 2014

Abstract: Objective The study analyzed the clinical distribution and drug sensitivity of hospital-acquired deep fungal infections, so as to provide a reference for the prevention and control of and the rational drug use against nosocomial infections. Methods Strains of detected fungi, drug susceptibility test results, and related clinical information among patients with deep fungal infections confirmed by laboratory at an AAA hospital between January of 2012 and December of 2014 were collected, organized, and analyzed. Results A total of 267 strains of hospital-acquired deep fungi were detected from 264 patients. Patients older than 60 years of age accounted for 78.11% and 34 of the patients died from the infections (fatality rate: 12.88%). The main sources of specimens were blood (37.08%) and sputum (34.83%). The four most common sources of patients were from the critical care medicine department, emergency department, geriatric ward, and hemopathology department. In general, drug resistances of Candida albicans against a variety of fungicides were weak, and drug resistances of smooth Candida mycoderma and tropical Candida mycoderma against triazole fungicides were strong.Conclusion The departments of critical care medicine, emergency, geriatric ward, and hemopathology are the key departments for prevention and control of hospital-acquired deep fungal infections. Presently, although fungal resistance has not been as severe of an issue as bacterial resistance, drug resistance of non-Candida albicans, especially that against triazoles, should be emphasized.