重症监护病房患者侵袭性真菌感染现状分析

目的分析重症监护病房（ICU）患者侵袭性真菌感染的好发部位、常见菌种及耐药性,并探讨其危险因素,为有效控制真菌感染及合理用药提供参考依据。方法对2012年1月—2013年7月入住我院ICU患者送检的各类标本进行真菌培养、菌种鉴定和真菌敏感试验。结果 824例患者中发生侵袭性真菌感染108例,感染发病率为13.11%；真菌感染部位以下呼吸道最为常见,占53.04%,其次为泌尿道（31.3%）、血液（6.08%）、肠道（4.36%）等；在所分离的115株真菌中,主要为白色假丝酵母菌（46.09%）、光滑假丝酵母菌（23.48%）、无名假丝酵母菌（11.3%）及热带假丝酵母菌（10.43%）；所有分离的菌株对5-氟胞嘧啶、两性霉素B敏感,对氟康唑、伊曲康唑及伏立康唑部分耐药；长期使用广谱抗生素、机械通气、侵入性操作、低蛋白血症、激素应用等是ICU患者侵袭性真菌感染的危险因素。结论 ICU患者侵袭性真菌感染部位以下呼吸道为主,白色假丝酵母菌最为常见；临床应重视病原学检查,合理使用抗菌药物,减少不必要的侵入性操作,提高机体免疫力是预防住院患者侵袭性真菌感染的主要措施。

Invasive fungal infection in intensive care unit

Objective To investigate the incidence features,common pathogens and drug resistance of invasive fungal infection in the intensive care unit（ICU）,to explore the risk factors of invasive fungal infection,and to provide a reference for invasive fungal infection control and rational use of antifungal drugs.Methods The samples collected from ICU patients between January 2012 and July 2013were used for fungal culture,identification and fungi susceptibility tests.Results Of the total 824 patients,108（13.11%） patients developed invasive fungal infection.The major infection site was lower respiratory tract（53.04%）,followed by urinary tract（31.3%）,blood（6.08%）,and intestinal tract（4.36%） etc.Of the totally isolated 115 strains,Candida albicans,C.glabrata,C.famata and C.tropicalis accounted for 46.09%,23.48%,11.3% and 10.43%,respectively.All the isolates were sensitive to 5-fluorocytosine（5-FC）and amphotericine B（AMB）,partial resistance to fluconazole,itraconazole and voriconazole.The risk factors were usage of broad-spectrum antibiotics,mechanical ventilation,invasive medical procedures,hypoproteinemia and glucocorticoid.Conclusions The major infection site of invasive fungal infection was lower respiratory tract,and Candida albicans was the main pathogen in ICU.Reasonable use of bacteriophage,reduction of unnecessary diagnosis and treatment procedures,and improving the immune function of inpatients are main measures to prevent fungal infection.