3759例角膜炎患者真菌检测与耐药性分析
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摘要
目的了解角膜感染真菌的分布与药敏情况,为临床诊治提供参考。方法回顾性分析2014年1月至2017年12月在本院就诊的角膜炎患者3759例。进行真菌培养及药敏实验,并汇总分析真菌分布与耐药性。结果 3759例真菌培养出阳性828例,总体阳性率为22%,患者以中老年男性为主,致病真菌以镰刀菌、链格孢霉及曲霉菌为主,其中镰刀菌最多,占比41%(340/828),且有增多趋势;其次为链格孢霉,占比30%(247/828)。真菌培养阳性率具有季节趋势,即在每年的第四季度真菌培养阳性率明显高于其他季度。抗真菌药伏立康唑、两性霉素B、伊曲康唑、酮康唑及氟康唑的耐药率分别为1.2%、1.6%、17.6%、32%及96.1%。结论本院眼角膜真菌感染以镰刀菌、链格孢霉为主且有增多趋势,时间分布呈季节性变化。氟康唑及酮康唑的耐药率较高,临床应根据真菌检验结果合理选择抗真菌药物及治疗方式。
Objective To investigate the pathogenic fungi distribution and drug resistance rate of fungal corneal infection, and to provide reference for clinical diagnosis and treatment. Method Retrospectively analyzed 3759 cases of keratitis patients in Qingdao eye hospital from January 2014 to December 2017. The keratitis patients datas were selected for fungal culture and drug resistance test, the results were collected and analyzed. Results The total positive rate was 22%(828 cases). Most of patients were old men, the most common fungi were Fusarium sp(41%), followed by Alternaria sp(30%). The positive rate of fungal culture in the fourth quarter of the year was significantly higher than those in the other quarters. The drug resistance rates of voriconazole, amphotericin B, itraconazole, ketoconazole and fluconazole were 1.2%, 1.6%, 17.6%, 32% and 96.1%. Conclusion Fungal infection of the cornea was on the rise and seasonal variation. The majority pathogens of fungal keratitis were Fusarium sp,followed by Alternaria sp. The drug resistance rates of fluconazole and ketoconazole were higher than that of other three antifungal drugs.
Objective To investigate the pathogenic fungi distribution and drug resistance rate of fungal corneal infection, and to provide reference for clinical diagnosis and treatment. Method Retrospectively analyzed 3759 cases of keratitis patients in Qingdao eye hospital from January 2014 to December 2017. The keratitis patients datas were selected for fungal culture and drug resistance test, the results were collected and analyzed. Results The total positive rate was 22%(828 cases). Most of patients were old men, the most common fungi were Fusarium sp(41%), followed by Alternaria sp(30%). The positive rate of fungal culture in the fourth quarter of the year was significantly higher than those in the other quarters. The drug resistance rates of voriconazole, amphotericin B, itraconazole, ketoconazole and fluconazole were 1.2%, 1.6%, 17.6%, 32% and 96.1%. Conclusion Fungal infection of the cornea was on the rise and seasonal variation. The majority pathogens of fungal keratitis were Fusarium sp,followed by Alternaria sp. The drug resistance rates of fluconazole and ketoconazole were higher than that of other three antifungal drugs.
引文
[1] 谢立信.感染性角膜病病原学诊断中存在的问题及对策[J].眼科,2010,19(3):145-147.
[2] 鹿秀海, 高彦, 张莉, 等. 真菌性角膜炎334 例的病原学分析[J].中华眼科杂志, 2013, 49(1):12-15.
[3] 孙士营,翟华蕾,史伟云,等.真菌性角膜炎致病菌种的变迁及体外药物敏感试验研究[J].中华检验医学杂志,2009,32(3):282-286.
[4] 刘素媛,刘立春,单秀水,等.感染性角膜炎的病原菌分析及药敏实验[J]。中国实用眼科杂志,2017,35(2):143-146.
[5] 徐红云,陈弟,刘海,等.感染性角膜炎的病原菌谱回顾性分析[J].中国感染与化疗杂志,2017,17(3):260-263.
[6] 王璐璐,韩雷,张月琴,等.真菌性角膜炎的临床转归及影响因素分析[J].中华实验眼科杂志,2016,34(8):734-738.
[7] 白雪晴,王智群,李然,等.角膜致病性丝状真菌基因分型与临床意义分析[J].眼科研究,2010,28(1):71-74.
[8] 张阳,王智群,孙旭光,等.2007至2016年我国北方地区真菌性角膜炎病原学及药物敏感性分析[J].中华眼科杂志,2018,54(6):432-436.
[9] 胡卫萍,林琳,周宏伟,等.浙北地区197例真菌性角膜炎感染特征分析[J].中华医院感染学杂志,2018,28(9):1328-1330
[10] 陈晓莲,刘红山,何宏,等.中国热带地区真菌性角膜溃疡致病菌种类及药物敏感性分析[J].中华实验眼科杂志,2017,35(2):156-160
[11] 龚桦,谭奕炜,龚向明,等.中国华南地区真菌性角膜炎致病菌谱变化[J].中华实验眼科杂志,2017,35(2):161-164
[12] 王友沛,顾云峰,徐一.温州地区真菌性角膜炎流行病学特征分析[J].中国卫生检验杂志,2015,25(19):3364-3365,3368
[13] 刘欣,吴尚操,戎佳燕,等.不同真菌菌属所致角膜炎的临床特点及转归差异[J].眼科新进展,2016,36(3):250-254.
[14] 王璐璐,韩雷,张月琴,等.真菌性角膜炎的临床转归及影响因素分析[J].中华实验眼科杂志,2016,34(8):734-738.
[15] 刘敬,谢立信,史伟云.主要致病真菌在角膜内生长方式的研究[J].眼科研究,2008,26(1):26-29.
[16] 梁玲玲,幸正茂,黄旭,等.真菌的生长方式对真菌性角膜炎治疗的影响[J].江西医药,2016,51(10):1097-1099
[17] 彭阳,许超,王玉月,等.丝状真菌的快速鉴定及药敏实验[J].临床检验杂志,2017,35(7):486-490.
[18] 中华医学会眼科学分会角膜病学组.感染性角膜病临床诊疗专家共识( 2011 年) [J].中华眼科杂志,2012,48(1) ∶ 72-75.
[19] 周玲芬,程凯尧,陈虹.真菌性角膜炎患者手术治疗效果分析[J].中华医院感染学杂志,2014,24(9):2267-2269.
[20] 祁媛媛,张立军,董贺,等.前节OCT辅助准分子激光治疗性角膜切削术治疗真菌性角膜溃疡[J].眼科新进展,2017,37(3):263-266.
[21] 程钧,翟华蕾,王君怡,等.角膜后部真菌感染的临床特点和治疗策略[J].中华眼科杂志,2017,53(10):758-765.
[2] 鹿秀海, 高彦, 张莉, 等. 真菌性角膜炎334 例的病原学分析[J].中华眼科杂志, 2013, 49(1):12-15.
[3] 孙士营,翟华蕾,史伟云,等.真菌性角膜炎致病菌种的变迁及体外药物敏感试验研究[J].中华检验医学杂志,2009,32(3):282-286.
[4] 刘素媛,刘立春,单秀水,等.感染性角膜炎的病原菌分析及药敏实验[J]。中国实用眼科杂志,2017,35(2):143-146.
[5] 徐红云,陈弟,刘海,等.感染性角膜炎的病原菌谱回顾性分析[J].中国感染与化疗杂志,2017,17(3):260-263.
[6] 王璐璐,韩雷,张月琴,等.真菌性角膜炎的临床转归及影响因素分析[J].中华实验眼科杂志,2016,34(8):734-738.
[7] 白雪晴,王智群,李然,等.角膜致病性丝状真菌基因分型与临床意义分析[J].眼科研究,2010,28(1):71-74.
[8] 张阳,王智群,孙旭光,等.2007至2016年我国北方地区真菌性角膜炎病原学及药物敏感性分析[J].中华眼科杂志,2018,54(6):432-436.
[9] 胡卫萍,林琳,周宏伟,等.浙北地区197例真菌性角膜炎感染特征分析[J].中华医院感染学杂志,2018,28(9):1328-1330
[10] 陈晓莲,刘红山,何宏,等.中国热带地区真菌性角膜溃疡致病菌种类及药物敏感性分析[J].中华实验眼科杂志,2017,35(2):156-160
[11] 龚桦,谭奕炜,龚向明,等.中国华南地区真菌性角膜炎致病菌谱变化[J].中华实验眼科杂志,2017,35(2):161-164
[12] 王友沛,顾云峰,徐一.温州地区真菌性角膜炎流行病学特征分析[J].中国卫生检验杂志,2015,25(19):3364-3365,3368
[13] 刘欣,吴尚操,戎佳燕,等.不同真菌菌属所致角膜炎的临床特点及转归差异[J].眼科新进展,2016,36(3):250-254.
[14] 王璐璐,韩雷,张月琴,等.真菌性角膜炎的临床转归及影响因素分析[J].中华实验眼科杂志,2016,34(8):734-738.
[15] 刘敬,谢立信,史伟云.主要致病真菌在角膜内生长方式的研究[J].眼科研究,2008,26(1):26-29.
[16] 梁玲玲,幸正茂,黄旭,等.真菌的生长方式对真菌性角膜炎治疗的影响[J].江西医药,2016,51(10):1097-1099
[17] 彭阳,许超,王玉月,等.丝状真菌的快速鉴定及药敏实验[J].临床检验杂志,2017,35(7):486-490.
[18] 中华医学会眼科学分会角膜病学组.感染性角膜病临床诊疗专家共识( 2011 年) [J].中华眼科杂志,2012,48(1) ∶ 72-75.
[19] 周玲芬,程凯尧,陈虹.真菌性角膜炎患者手术治疗效果分析[J].中华医院感染学杂志,2014,24(9):2267-2269.
[20] 祁媛媛,张立军,董贺,等.前节OCT辅助准分子激光治疗性角膜切削术治疗真菌性角膜溃疡[J].眼科新进展,2017,37(3):263-266.
[21] 程钧,翟华蕾,王君怡,等.角膜后部真菌感染的临床特点和治疗策略[J].中华眼科杂志,2017,53(10):758-765.