临床真菌血流感染的菌株分布及耐药性分析
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摘要
目的分析临床真菌血流感染的病原菌分布及耐药特征,为真菌血流感染的诊治提供理论依据。方法回顾性分析2015年1月~2017年12月临床真菌血流感染的菌株分布及药敏试验结果。结果共分离264例真菌。近平滑念珠菌检出率最高(53.79%),其次是角膜假丝酵母(13.63%)和白念珠菌(7.58%)。检出念珠菌数前三位科室依次为普外科(32.58%)、心血管外科(21.59%)和胸外科(8.33%)。对氟康唑、伊曲康唑和伏立康唑的敏感率,白念珠菌均为100%;近平滑念珠菌分别为100%,99.3%和100%;角膜假丝酵母分别为94.4%,19.4%和97.2%。对于5-氟胞嘧啶,白念珠菌敏感率100%,近平滑念珠菌和角膜假丝酵母的敏感率仅为70.4%和11.1%。三者对两性霉素B的敏感率≥95%。结论近平滑念珠菌是该院临床血流感染最常见的真菌,绝大部分念珠菌对抗真菌药物的敏感率较高。要高度重视病原学监测,规范临床抗真菌药物的合理应用。
Objective To investigate the pathogen distribution and drug susceptibility profile of fungal isolates from bloodstream infections,and provide the basis for clinical diagnosis and treatment.Methods A retrospective analysis was carried out to analysis the fungal pathogens isolated from bloodstream infections in Changhai Hospital during the period from January 2015 to December 2017.Pathogen distribution and antibiotic resistance for the fungal infections were analyzed.ResultsA total of 264 fungal strains were isolated.There were 142 Candida parapsilosis(53.79%),36 Candida pelliculosa(13.63%)and 20 Candida albicans(7.58%).These patients mainly came from the department of general surgery(32.58%),cardiovascular surgery(21.59%)and thoracic surgery(8.33%).Drug sensitive test showed that sensitivity of Candida parapsilosis to fluconazole,itraconazole and voriconazole were 100%,99.3%and 100%,whereas Candida pelliculosa were 94.4%,19.4%and 97.2%,respectively.Candida albicans isolates were 100%susceptible to all the azole antifungal drugs.The sensitivity of Candida albicans,Candida parapsilosis,and Candida pelliculosa to 5-fluorocytosine were100%,70.4% and 11.1%,respectively.The susceptible rate of all strains to Amphotericin B were high.Conclusion The main pathogen of fungemia was Candida parapsilosis.Most of the candidas were susceptible to antifungal drugs.Intensifying the pathogen surveillance,making an early diagnosis and early experience antifungal therapy are more important to reduce the mortality of fungal infection.
Objective To investigate the pathogen distribution and drug susceptibility profile of fungal isolates from bloodstream infections,and provide the basis for clinical diagnosis and treatment.Methods A retrospective analysis was carried out to analysis the fungal pathogens isolated from bloodstream infections in Changhai Hospital during the period from January 2015 to December 2017.Pathogen distribution and antibiotic resistance for the fungal infections were analyzed.ResultsA total of 264 fungal strains were isolated.There were 142 Candida parapsilosis(53.79%),36 Candida pelliculosa(13.63%)and 20 Candida albicans(7.58%).These patients mainly came from the department of general surgery(32.58%),cardiovascular surgery(21.59%)and thoracic surgery(8.33%).Drug sensitive test showed that sensitivity of Candida parapsilosis to fluconazole,itraconazole and voriconazole were 100%,99.3%and 100%,whereas Candida pelliculosa were 94.4%,19.4%and 97.2%,respectively.Candida albicans isolates were 100%susceptible to all the azole antifungal drugs.The sensitivity of Candida albicans,Candida parapsilosis,and Candida pelliculosa to 5-fluorocytosine were100%,70.4% and 11.1%,respectively.The susceptible rate of all strains to Amphotericin B were high.Conclusion The main pathogen of fungemia was Candida parapsilosis.Most of the candidas were susceptible to antifungal drugs.Intensifying the pathogen surveillance,making an early diagnosis and early experience antifungal therapy are more important to reduce the mortality of fungal infection.
引文
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[2]文艳,刘爱胜,张勇,等.ICU危重病患者深部真菌感染血清中降钙素原和(1,3)-β-D葡聚糖联合检测的临床意义[J].现代检验医学杂志,2015,30(2):120-122.Wen Y,Liu AS,Zhang Y,et al.Diagnosis value of joint detection of critical patients procalcitonin and(1,3)-β-D glucan with deep fungus infection in ICU[J].J Mod Lab Med,2015,30(2):120-122.
[3]Garnacho-Montero J,Diaz-Martin A,Garcia-Cabrera E,et al.Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp.bloodstream infections[J].J Antimicrob Chemother,2013,68(1):206-213.
[4]Goncalves SS,Souza AC,Chowdhary A,et al.Epidemiology and molecular mechanisms of antifungal resistance in Candida and Aspergillus[J].Mycoses2016,59(4),198-219.
[5]尚红,王毓三,申子瑜.全国临床检验操作规程[S].4版.北京:人民卫生出版社,2014.Shang H,Wang YS,Shen ZY.National Guide to Clinical Laboratory Procedures[M].4th Ed.Beijing:People’s Publishing House,2014.
[6]Li D,Zhang WF,Zheng S,et al.Surveillance study of candidemia in cancer patients in North China[J].Med Mycol,2013,51(4):378-384.
[7]Arias S,Denis O,Montesinos I,et al.Epidemiology and mortality of candidemia both related and unrelated to the central venous catheter:a retrospective cohort study[J].Eur J Clin Microbiol Infect Dis,2017,36(3):501-507.
[8]Liu Y,Kang M,Ye H,et al.Analysis on clinical characteristics and drug resistance of Candida parapsilosis bloodstream infections in West China Hospital,China,from 2012to 2015[J].J Mycol Med,2018,28(1):222-226.