心脏外科监护室真菌感染临床和病原学分析

目的探讨心脏外科监护室(CSICU)患者医院真菌感染的病原学和药敏特点。方法收集患者的痰、血、尿、中心静脉导管顶端及局部引流物进行真菌培养并作药物敏感性试验。结果42例患者中共分离出病原菌52株。其中酵母类真菌为43株(82.7%),曲霉菌为9株(17.3%)。酵母类真菌主要为白假丝酵母菌和热带假丝酵母菌。对白假丝酵母菌耐药率最低的是咪康唑、酮康唑、氟康唑和克霉唑(<9.5%)。其次为伊曲康唑和制霉菌素(12.5～14.3)%;对热带假丝酵母菌耐药率最低的是两性霉素、咪康唑、制霉菌素(0.0%),其他耐药在25.0%～46.3%。医院感染率为9.5%,病死率为26.2%。结论CSICU患者真菌感染主要发生在下呼吸道,以白色假丝酵母菌居多,对咪唑类抗真菌药物敏感。感染发生与基础疾病、术后危重状态、广谱抗菌素的应用,及各种侵入性诊疗技术的实施有密切关系。

Clinical and etiological analysis with invasive fungal infections in cardiosurgery intensive care unit

[Objective] To discuss the clinical characteristic and drug susceptibility of nosocomial fungus infection of Cardiosurgery Intensive Care Unit(CSICU).[Methods] Fungus isolated form sputum,blood,urine,central venous catheter and local drain from the 42 patients were infected and analyzed during July 2002 to November 2006.[Results] An account of 52 fungus were identified.Fungus were isolated from at least one location from 42 cases.Yeasts took up 82.7%,mainly including Candida albicans(50.0%) and Candida tropicalis(23.1%).The Candia albica had a lower degree of resistance to Ketoconazoie,Miconazole,Fluconazole and Clotrimazole(<9.5%) and a higher degree of resistance to Itraconazole,Amphotericin and Flucytosine(>20.0%).The Candia tropicalis had a lower degree of resistance to Amphotericin,Miconazole and Nystatin had a higher degree of resistance to other Antifungals.The most common sites of infection were lower respiratory tract,followed by wound,urinary tract and blood.The nosocomial infection rate was 9.5%.[Conclusions] Lower respiratory tract was the major Fungal infection site in CSICU.Most of Fungus were Candida albicans,which were sensitive to Ketoconazoie,Miconazole Fluconazole and Clotrimazole.The Fungal infections were closely related with basic diseases,postoperative critical conditions,using of broad-spectrum antibiotics and various invasive diagnostic and treatment technologies.