侵袭性深部真菌感染45例临床和病原学分析  

Clinical and etiological analysis of 45 cases with invasive fungal infections

作　　者：徐俊芳[1] 叶信予[1] 吴菊芳[1] 

机构地区：[1]复旦大学附属华山医院抗生素研究所,上海200040

出　　处：《中国感染与化疗杂志》2006年第3期145-148,共4页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解本院深部真菌感染的发病状况、病原菌特性及对常用抗真菌药的敏感度,为临床深部真菌感染的治疗药物选用提供依据。方法回顾性分析我院2004年1月1日—12月31日血、无菌体腔液真菌培养阳性患者的病史,并对收集的病原菌进行体外药敏测定。结果根据诊断标准,确诊为深部真菌感染患者45例。其中社区获得性深部真菌感染22例,医院深部真菌感染23例。社区获得性深部真菌感染的部位以中枢神经系统最常见,共21例,占95.5%;其次为下呼吸道感染1例。医院深部真菌感染最常见的部位为血流感染,共15例,占65.2%;其次为中枢神经系统感染5例;下呼吸道感染2例;腹腔感染2例。社区获得性感染最常见的病原菌为新型隐球菌,共17株,占77.3%;其次为白念珠菌4株;烟曲霉1株。医院感染最常见的病原菌为白念珠菌,共8株;其次为其他念珠菌属。医院感染可能与住院天数较长、高龄、大手术、长时间应用广谱抗生素、深静脉置管等因素有关。结论我院2004年深部真菌感染确诊病例中,医院感染以白念珠菌所致的血流感染最常见;社区获得性感染以隐球菌性脑膜炎最多见。氟康唑仍是治疗敏感念珠菌属尤其是白念珠菌感染的有效药物。Objective This study was conducted in Huashan Hospital, Fudan University to understand the clinical features and pathogens of invasive fungal infections and the response to antifungal therapy. Methods From January to December 2004, all patients of Huashan Hospital with positive result for fungal culture of blood and sterile fluid were reviewed retrospectively. The in vitro activity of antifungal agents against fungal isolates was determined. Results Forty five patients were included in this analysis based on the diagnosis of invasive fungal infection, 22 were community acquired and the remaining 23 were hospital acquired. The most common site of community acquired infection was central nervous system （21/22）, followed by lower respiratory tract （1/22）; while hospital acquired infection was mainly in bloodstream （15/23）, and followed by central nervous system （5/23）, lower respiratory tract （2/23） and abdominal infection （2/23）. The identified pathogen of community-acquired fungal infections included Cryptococcus neoformans （ n = 17, 77.3 % ）, Candida a lbicans （n = 4） and Aspergillus fumigatus （ n =1）. Hospital fungal infection was due to C, albicans （n=8）, C. glabrata （n=6）, C. tropicalis （n=4）, C. parapsilosis in = 2）, C. guilliermondii （n= 2） or C. krusei in = 1 ）. The predisposing factors of invasive fungal infection included longer hos pital stay, advanced age, major operation, long term use of broad spectrum antibiotic, and placement of deep venous line. In vitro sensitivity test showed that fluconazole had excellent activity against C. albicans and most C. neoformans isolates, but dose-depended activity for non albicans species. Conclusions Bloodstream infection caused by C. albicans is the most common hospital-acquired fungal infection in our hospital. Central nervous system infection due to C. neoformans is the most common community-acquired fungal infection. Fluconazole remains effective for treatment of candidal infections, especially those caused

关 键 词：真菌感染 深部 隐球菌 念珠菌 氟康唑 

分 类 号：R519[医药卫生—内科学]