无菌部位真菌感染的临床分布及耐药性分析  

The Clinical Distribution and Drug Resistance of Fungal Infection in Sterile Sites

作　　者：王岚[1] 吴怡[1] 刘新[1] 张翀[2] 王东月[3] 

机构地区：[1]沈阳医学院病原生物学教研室,辽宁省沈阳市110034 [2]沈阳医学院附属中心医院检验科 [3]沈阳医学院2012级临床医学15班

出　　处：《中国全科医学》2015年第7期831-833,共3页Chinese General Practice

基　　金：辽宁省科技厅项目(2013001014)

摘　　要：目的探讨临床常见无菌部位真菌感染种类及耐药性特点,为临床提供病原学诊断和合理使用抗真菌药物的依据。方法收集沈阳医学院附属中心医院2013年7—12月住院及门诊送检无菌部位标本进行培养,分离出真菌并鉴定到种,对常见真菌进行药敏试验分析。结果在分离出的122株真菌标本中,感染阳性标本前5位分别是:尿液(68.9%,84/122)、各种引流液(9.0%,11/122)、血液(8.2%,10/122)、脑脊液(3.3%,4/122)、腹腔积液(2.4%,3/122);前3位的科室分别是:老年科(21.3%,26/122)、ICU(18.9%,23/122)、内分泌科(16.4%,20/122);前5位的菌种分别是:白假丝酵母菌(29.5%,36/122)、光滑假丝酵母菌(24.6%,30/122)、热带假丝酵母菌(22.1%,27/122)、克柔假丝酵母菌(5.7%,7/122)、新型隐球菌(3.3%,4/122)。常见真菌对常见抗真菌药物的敏感性由高到低依次为两性霉素B(98.1%,102/104)、5-氟胞嘧啶(97.1%,101/104)、伏立康唑(87.5%,91/104)、氟康唑(82.7%,86/104)、伊曲康唑(74.0%,77/104)。结论无菌部位真菌感染以白假丝酵母菌为主,两性霉素B与5-氟胞嘧啶具有较强的抑制真菌作用,临床医生应重视实验室真菌培养与鉴定结果,合理使用抗真菌药物。Objective To investigate species and drug resistance characteristics of fungal infection commonly found in sterile sites and provide evidences for aetiological diagnosis and reasonable use of antifungal drugs in clinic practice. Methods We collected specimens of sterile sites delivered from the Central Hospital Affiliated to Shenyang Medical College between July and December in 2013. Fungi were cultured in and extracted from these specimens, and the species were then identified. Drug sensitive tests were conducted in common fungi. Results The result of the test on 122 strains of fungus extracted showed that the five involved sterile sites with the highest proportions were sequentially urine（ 68. 9%,84 /122）,various kinds of drainage fluid（ 9. 0%,11 /122）,blood（ 8. 2%,10 /122）,cerebrospinal fluid（ 3. 3%,4 /122） and ascites（ 2. 4%,3 /122）; the involved departments with the highest proportions were geriatrics（ 21. 3%,26 /122）,ICU（ 18. 9%,23 /122）,endocrinology（ 16. 4%,20 /122）; the five species of fungus with the highest proportions were Candida albicans（ 29. 5%,36 /122）,Candida glabrata（ 24. 6%, 30 /122）, Candida tropicalis（ 22. 1%, 27 /122）, Monilia krusei（ 5. 7%, 7 /122） and Cryptococcus neoformans（ 3. 3%,4 /122）. Common antifungal drugs,to which common fungi had the highest sensitivity rates,were amphotericin B（ 98. 1%, 102 /104）, 5- flucytosine（ 97. 1%, 101 /104）, voriconazole（ 87. 5%, 91 /104）,fluconazole（ 82. 7%,86 /104）, and itraconazole（ 74. 0%,77 /104）. Conclusion The fungal infection in sterile sites primarily occurs as Candida albicans. Amphotericin B and 5- flucytosine have relatively stronger fungistasis. Clinicians should attach more importance to the results of fungal culture and identification in laboratory and reasonable use of antifungal drugs.

关 键 词：真菌 无菌部位 临床分布 耐药性 

分 类 号：R379.4[医药卫生—病原生物学]