老年患者泌尿系真菌感染的临床分析

目的 了解老年患者泌尿系真菌感染的菌群分布情况及其耐药性特点，以指导临床合理使用抗真菌药物。方法 对本院老年医学科2016年1月—2019年4月临床泌尿系感染老年患者分离出的真菌菌株进行回顾性分析。结果 总共分离出278株真菌，其中以白念珠菌为主，占52.2%，其次是热带念珠菌，占23.7%，光滑念珠菌11.5%，克柔念珠菌6.1%，近平滑念珠菌3.2%及其他念珠菌(葡萄牙念珠菌、季也蒙念珠菌)3.3%，分离出的真菌菌株对伊曲康唑、氟康唑的耐药率相对较高，对伊曲康唑的耐药率分别为18.6%、15.1%、21.9%、35.3%、11.1%和0，对氟康唑的耐药率分别为8.9%、7.6%、25.0%、100%、0和0，分离的菌株对两性霉素B和5-氟胞嘧啶均敏感，对伏立康唑的平均耐药率为5.0%。结论 本院老年医学科泌尿系真菌感染以白念珠菌、热带念珠菌为主，且检出的真菌对伊曲康唑、氟康唑、伏立康唑已出现不同程度的耐药性，因此，加强监测各种真菌的耐药情况对临床合理使用抗真菌药物显得尤为重要。

Clinical analysis of the elderly patients with urinary tract fungal infections

Objective To investigate the bacterial floral distribution and drug resistance of the urinary tract fungal infections in the elderly patients, and to guide the rational use of antifungal drugs in clinic. Methods Retrospective analysis was made for the clinical fungal strains, which were isolated from January 2016 to April 2019 in the urinary tract fungal infections in the elderly patients. Results 278 Strains were selected and most of the fungi were Candida albicans (52.2%), and the next were Candida tropicalis (23.7%), Candida glabrata (11.5%), Candida krusei (6.1%), Candida parapsilosis (3.2%) and other Candida (3.3%). The isolated fungi were more resistant to itraconazol and fluconazole. The rates of drug resistance to itraconazol were 18.6%, 15.1%, 21.9%, 35.3%, 11.1% and 0, and to fluconazole were 8.9%, 7.6%, 25.0%, 100%, 0 and 0, respectively. They were all sensitive to amphotericin B and 5-fluorocytosine. The average rates of drug resistance to voriconazole were 5.0%. Conclusion The main fungi causing urinary tract infections were Candida albicans and Calbicans tropicalis in our hospital. The detected fungi had different levels of drug resistance to itraconazol, fluconazole, and voriconazole, and therefore it is important to strengthen the surveillance of drug resistance for using antifungal medicines rationally.