福建省某三甲医院真菌血流感染的临床分布及药敏分析  

Clinical Distribution and Drug Sensitivity Analysis of Fungal Bloodstream Infection in a Grade-A Tertiary Hospital in Fujian Province

作　　者：杨煌 徐小红[1] 张蕊 李彬[1] YANG Huang;XU Xiaohong;ZHANG Rui;LI Bin(Department of Laboratory Medicine,Fujian Medical University Union Hospital,Fuzhou 350001,China;School of Medical Technology and Engineering,Fujian Medical University,Fuzhou 350122,China)

机构地区：[1]福建医科大学附属协和医院检验科,福州350001 [2]福建医科大学医学技术与工程学院,福州350122

出　　处：《福建医科大学学报》2024年第6期418-424,共7页Journal of Fujian Medical University

基　　金：福建省卫生健康中青年领军人才研修培养项目(14003)。

摘　　要：目的分析医院内真菌血流感染的菌种分布及耐药性水平,了解不同科室的菌株分布特点,为临床感染的预防和治疗提供参考依据。方法收集2021年1月-2023年12月281例真菌血流感染患者的血液标本,进行菌种分离、质谱鉴定及药物敏感性试验,并对结果进行统计和分析。结果男性真菌血症患者的比例显著高于女性患者。科室分布上重症监护室占比最高(35.2%),其次为血液科(20.6%)、急诊科(12.1%)和心外科(11.4%)。主要感染的真菌为白念珠菌(33.5%)、热带念珠菌(29.9%)、近平滑念珠菌(18.5%)、马尔尼菲蓝状菌(5.3%)和新型隐球菌(3.2%)。药物敏感(药敏)测试结果显示,白念珠菌对氟康唑、伏立康唑和两性霉素B的敏感性较高;热带念珠菌对三唑类药物敏感性较低,仅对两性霉素B表现出较高的敏感性;近平滑念珠菌对主要抗真菌药物均表现出较高的敏感性。分层分析显示,血液科患者分离出的真菌对抗真菌药物的总体敏感性较低。结论医院内不同科室真菌血流感染的菌株分布和药敏特征存在差异。白念珠菌和近平滑念珠菌对常用抗真菌药物的敏感性较高,而热带念珠菌对三唑类药物的敏感性较低。血液科在临床治疗时需要特别关注热带念珠菌耐药性问题。Objective To analyze the species distribution and drug resistance levels of fungal bloodstream infections in a hospital and to understand the characteristics of strain distribution across different departments.This study aims to provide reference information for the prevention and treatment of this clinical infection.Methods Blood samples were collected from 281 patients with fungal bloodstream infections from January 2021 to December 2023.The fungal strains were isolated,identified using mass spectrometry,and tested for drug susceptibility.The results were statistically analyzed.Results The proportion of male patients with fungemia was significantly higher than that of females.The intensive care unit(ICU)had the highest distribution(35.2%),followed by the Hematology department(20.6%),Emergency department(12.1%),and Cardiovascular surgery department(11.4%).The main fungi causing infections were Candida albicans(33.5%),Candida tropicalis(29.9%),Candida parapsilosis(18.5%),Talaromyces marneffei(5.3%),and Cryptococcus neoformans(3.2%).Drug susceptibility tests showed that Candida albicans had high sensitivity to fluconazole,voriconazole,and amphotericin B.Candida tropicalis exhibited low sensitivity to azole drugs,but showed good sensitivity only to amphotericin B.Candida parapsilosis demonstrated good sensitivity to all major antifungal drugs.Stratified analysis revealed that fungal strains isolated from Hematology department patients generally exhibited lower overall sensitivity to antifungal drugs.Conclusion The distribution of fungal strains and their drug susceptibility characteristics vary across different departments within the hospital.Candida albicans and Candida parapsilosis show good sensitivity to common antifungal drugs,while Candida tropicalis has low sensitivity to azole drugs.Special attention should be paid to the issue of drug resistance in Candida tropicalis when treating patients in the Hematology department.

关 键 词：真菌血症 耐药性 发病率 念珠菌 

分 类 号：R44[医药卫生—诊断学]