150例重症肝病合并院内真菌感染的病例分析

目的 探讨重症肝病患者医院真菌感染的临床和药敏特点。方法 应用回顾性调查方法对150例重症肝病患者医院真菌感染临床资料及相关因素进行分析。结果 150例重症肝病患者医院真菌感染部位以上呼吸道为主，占45．33％；其次为下呼吸道、肠道、腹腔、胆道。分别为23．33％、21．33％、20．00％、18．67％。感染菌种以白色念珠菌为主，占50．67％；其次为热带念珠菌，占18．87％。感染真菌对7种抗真菌药物的敏感性为：对二性霉素B较高的敏感性，达90％左右；其次为氟康唑，达80％左右。对益康唑、酮康唑、伊曲康唑、咪康唑有不同程度的耐药，而对制霉菌素呈明显的耐药，达70％。真菌混合2种细菌感染者死亡率达80％．明显高于混合1种细菌感染者（P〈0．01）。应用广谱抗菌素、白细胞减少、侵袭性操作、疾病严重程度是重症肝病并发真菌感染的密切相关因素（P〈0．01）。结论 重症肝病患者院内真菌感染混合细菌感染预后差，死亡率极高：医院感染真菌对常用抗真菌药物有一定的耐药性，应引起临床的高度重视；预防和治疗医院真菌感染需采取综合措施。

The Clinical Characteristic and Drug Susceptibility of Nosocomial Fungus Infection of Severe Hepatitis Patients

Objective To discuss the clinical characteristic and drug susceptibility of nosocomial fungus infection of severe hepatitis patients. Methods 150 hospitalized cases of severe hepatitis patients with nosocomial fungus infection were investigated and analyzed retrospectively. Results Fungus infection of upper respiratory tract accounted for 45.33%, infection rates in lower respiratory tract, intestinal tract, abdominal cavity and bile duct were 23.33%, 21.33%, 20.00%, and 18.67%, respectively. Candida albicans accounted for 50.67% and Albicans tropicals for 18.87%. The susceptibility to seven antibiotics: the susceptibility rates of all fungi to amophotericin were about 90%, and to fluconazole were about 80%. All the fungi showed certain degree of resistance to enconazole, ketoconazole, itraconazole, and miconazole. The resistance rates of all fungi to nystatin were 70%. The mortality of patients co-infected by two strain bacteria was 80%, and it was higher than that by one strain bacterium (P < 0.01). Use of broad-spectrum antibiotic, neutropenia, improper medical manipulations and severity of liver disease were risk factors of fungus infection (P < 0.01). Conclusion The mortality of severe hepatitis patients with nosocomial fungus infection coinfected by bacteria was very high. All the fungi showed certain degree of resistance to routinely used antibiotics. Comprehensive measures must be administrated to prevent and treat nosocomial fungus infection.