2013-2015年真菌血流感染病原真菌分布及药敏分析  

Pathogen distribution and susceptibility profile of fungal isolates from bloodstream infections during the period from 2013 through 2015

作　　者：魏凌 夏文颖 王珏 文怡 刘根焰 赵旺胜 梅亚宁 

机构地区：[1]镇江市中医院检验科,江苏镇江212001 [2]南京医科大学第一附属医院检验学部

出　　处：《中国感染与化疗杂志》2017年第3期256-259,共4页Chinese Journal of Infection and Chemotherapy

基　　金：江苏省实验诊断学重点实验室基金(xk201114);南京医科大学"十二五"教育研究课题(JYY2015020)

摘　　要：目的了解血流感染常见病原真菌的菌群分布及药物敏感状况,评估(1,3)-β-D-葡聚糖检测(G试验)的临床价值,为临床真菌感染提供病原学诊断和合理使用抗真菌药物的依据。方法回顾性分析南京医科大学第一附属医院2013年1月-2015年12月真菌血流感染的的菌群分布及药物敏感状况,同步分析G试验检测结果。结果 3年共分离真菌114株,以念珠菌属为主(86.8%,99/114),其中以白念珠菌比例最高,占30.7%。真菌血流感染科室分布以胸外科、血液科、ICU多见,占41.2%,其中胸外科感染逐年减少(2013年5例10株,2014年2例5株,2015年3例4株),血液科和ICU在2014年最高,分别有11株和7株。药敏结果显示血流感染真菌对两性霉素B最为敏感,敏感率达到100%,对伊曲康唑敏感率最低,平均敏感率仅为83.5%。88例患者中54例进行了G试验检测,其中13例G试验先于血培养出现阳性结果。结论真菌血流感染以念珠菌属为主,抗真菌药物中两性霉素B的抗真菌活性最强,血培养与血清学试验联合检测,可给临床提供较早且可靠的诊断依据。Objective To investigate the pathogen distribution and susceptibility profile of fungal isolates from bloodstream infections, and valuate the clinical utility of G test in diagnosis of fungal infections for the purpose to improve antifungal therapy. Methods A retrospective analysis was carried out to analyze the fungal pathogens isolated from bloodstream infections in the First Affiliated Hospital of Nanjing Medical University during the period from January 2013 through December 2015 and their antimicrobial susceptibility. Results A total of 114 fungal strains were isolated from bloodstream infections during the 3-year period, most of which were Candida （99/114, 86.8%）, especially Candida albicans （30.7%）. About 41.2% （47/114） of the fungal strains were isolated from Department of Thoracic Surgery （10, 5 and 4 strains in 2013, 2014 and 2015）, Hematology （11 strains in 2014）, and ICU （7 strains in 2014）. Antimicrobial susceptibility testing showed that all the fungal strains （100%） were susceptible to amphotericin B, but 83.5% susceptible to itraconazole （the lowest）. G test was positive before the result of blood culture in 13 of the 54 patients Amphotericin B is earlier and reliable who received G test. Conclusions Candida was the most common fungus in fungal bloodstream infection. the most active antifungal agent in vitro. Blood culture combined with serological test can provide clinicians an diagnosis.

关 键 词：血流感染 真菌 (1 3)-β-D-葡聚糖检测 药敏试验 

分 类 号：R446.5[医药卫生—诊断学] R519[医药卫生—临床医学]