消化道肿瘤患者真菌感染的临床特点及耐药性分析  

Clinical characteristics of fungal infections in patients with gastrointestinal tumors and analysis of drug resistance

作　　者：尹秀云[1] 于农[1] 曾利军[1] 蒋虔[1] 王琳[1] 宋世平[1] 张伟[1] 李一鹤[1] 杨哲[1] 徐建民[1] 陈建魁[1] 陈水平[1] 

机构地区：[1]军事医学科学院附属医院检验科,北京100071

出　　处：《中华医院感染学杂志》2014年第21期5242-5244,共3页Chinese Journal of Nosocomiology

基　　金：国家重大科学专项基金资助项目(2012YQ18011708);国家科技重大专项基金资助项目(2013ZX10004203)

摘　　要：目的探讨消化道肿瘤患者真菌感染的种类分布及耐药性,为其预防及诊治提供理论依据。方法回顾性分析2013年1-12月消化道肿瘤患者真菌感染的种类分布及耐药性,病原菌培养、鉴定和药敏试验严格按照《全国临床检验操作规程》进行,采用WHONET5.6软件对数据进行统计分析。结果 87例真菌感染患者感染部位以下呼吸道为主,占80.5%,其次为消化道占17.2%;送检标本中共检出真菌90株,其中以白色假丝酵母菌为主,占64.4%,其次为热带假丝酵母菌、光滑假丝酵母菌,分别占13.3%、11.1%;真菌感染患者中53例发生二重感染,发生率60.9%,发生二重感染的细菌主要以肺炎克雷伯菌和鲍氏不动杆菌为主,分别占28.3%、24.5%;克柔假丝酵母菌、光滑假丝酵母菌对伊曲康唑的耐药率较高,分别为71.4%、60.0%,白色假丝酵母菌、热带假丝酵母菌、光滑假丝酵母菌、克柔假丝酵母菌对伏立康唑、两性霉素B的敏感性高,无耐药菌检出。结论消化道肿瘤患者以下呼吸道真菌感染最多见;二重感染的发生率较高,检出真菌主要为白色假丝酵母菌,细菌主要肺炎克雷伯菌;对晚期肿瘤下呼吸道感染患者应及时进行病原学检测,根据检验结果合理应用敏感抗菌药物进行治疗,有效地控制医院感染。OBJECTIVE To analyze the distribution and drug resistance of the fungi causing infections in the patients with gastrointestinal tumors so as to provide theoretical basis for prevention and treatment. METHODS From Jan 2013 to Dec 2013, the distribution and drug resistance of the fungi causing infections in the patients with gastrointestinal tumors were retrospectively analyzed, then the culture, identification, and drug susceptibility testing were performed according to National clinical laboratory operation procedures, and the statistical analysis was performed by using WHONET5. 6 software. RESULTS Of 87 patients with fungal infections, 80. 5% were with lower respiratory tract infections, and 17. 2% were with gastrointestinal tract infections. Totally 90 strains of fungi were isolated from the submitted specimens, among which Candida albicans accounted for 64. 4%, followed by C. tropicalis （13. 3% ） and C. glabrata （11. 1% ）. Among the patients with fungal infections, the superinfectionsoccurredin53caseswiththeincidencerateof60.9% ;theKlebsiellapneumoniaeandAcinetobact-er baumannii were the predominant species of pathogens causing superinfections, accounting for 28. 3% and 24. 5%, respectively. The drug resistance rates of the Candida krusei and C. glabrata were 71. 4% and 60. 0%, respectively ;the C. albicans, C. tropicalis, C. glabrata, and C. krusei were highly susceptible to voriconazole and amphotericin B, and the drug-resistant strains were not detected. CONCLUSIONS The lower respiratory tract infections caused by the fungi are most common in the patients with gastrointestinal tumors ;the incidence of the superinfections is high ;the C. albicans is the predominant species of isolated fungi, and the K. pneumoniae is dominant among the isolated bacteria.It is an effective way to perform etiological examination for the advanced tumor patients with lower respiratory tract infections in a timely manner and reasonably use antibiotics based on the results of drug susceptibility testing so as to control nos

关 键 词：消化道肿瘤 患者 真菌感染 二重感染 抗菌药物 

分 类 号：R379[医药卫生—病原生物学]