赵辉 王群 赵冰  王宁  薛宏

[摘要] 目的 了解深部真茵感染的临床分布特点及耐药情况，以指导临床合理应用抗真菌药物。 方法 收集我院临床患者深部的标本(痰液、尿液、粪便、血液、脑脊液、生殖道分泌物、创口分泌物)共426份，接种到沙保弱培养基和显色培养基鉴定菌株。将分纯的菌种接种梅里埃公司生产的ATB Fungus 2真菌药敏板条，用ATB Expression鉴定仪读取最小抑菌浓度(MIC)，得出临床常见真菌对抗真菌药物的药敏结果。 结果 发生深部真菌感染167例，感染真菌标本以痰液检出率最高为63.5%，其次为尿液占15.6%。167株真菌中，假丝酵母菌属感染有160株，其中以白假丝酵母菌为主（67.1%，112/167）。科室分布中，干诊科感染率最高，为41.9%；其次为呼吸科，占26.3%。＞60岁老年患者有123例，占73.6%。假丝酵母菌属对伏立康唑和伊曲康唑的耐药率较高，分别为75.05%和51.10%，对5-氟胞嘧啶和两性霉素B耐药率较低，分别为2.20%和2.90%。 结论 老年患者容易患深部真菌感染，感染部位主要为呼吸道，假丝酵母菌属为主要病原菌，其中以白假丝酵母菌感染率最高；两性霉素B、氯康唑和5-氟胞嘧啶耐药率最低，氟立康唑和伊曲康唑的耐药率最高。

[关键词] 深部真菌感染；临床分布特点；耐药性；抗真菌药物

[中图分类号] R379   [文献标识码] B   [文章编号] 2095-0616（2014）08-52-04

An analysis of characteristics and drug resistance of deep fungal infection

ZHAO Hui1  WANG Qun1  ZHAO Bing1  WANG Ning2  XUE Hong1

1.Department of Clinical Laboratory, the Second Affiliated Hospital of Shenyang Medical College,Shenyang 110001,China; 2.Department of Clinical Laboratory, Affiliated Central Hospital of Shenyang Medical College,Shenyang 110024,China

[Abstract] Objective To understand the characteristics of clinical distribution and drug resistance of deep fungal infection,so as to guide appropriate clinical application of antifungal drugs. Methods 426 deep samples (sputum,urine,excrement,blood,cerebrospinal fluid, genital secretions and wound secretions) from clinical patients in our hospital were collected and cultured in Sabourand's medium and chromogenic media used to identify bacterial strains.The isolated strains were then cultured in an antifungal susceptibility strip of ATB Fungus 2 produced by the bioMérieux Group, and minimum inhibitory concentration was obtained via an identification instrument of ATB Expression. The drug susceptibility regarding clinically commonly seen fungus against antifungal drugs was obtained. Results 167 deep fungal infections were detected.The detection rate of infected fungal samples in sputum was 63.5%, the highest one.The second highest rate was in urine, accounting for 15.6%.Among 167 strains of fungus, 160 strains belonged to Candida infection, in which the majority was Candida albicans(67.1%,112/167).In departments, the highest infection rate of 41.9% was seen in the department of elderly officials;the second infection rate of 26.3% was seen in the department of pneumology.123 patients were older then 60 years of age,accounting for 73.6%.The drug resistance of genus Candida was relatively high against voriconazole and itraconazole,accounting for 75.05% and 51.10% respectively.Its drug resistance was relatively low against 5-fluorocytosine and amphotericin B, accounting for 2.20% and 2.90% respectively. Conclusion Elderly patients tend to be infected with deep fungus,and the main infected position is respiratory tract. Genus Candida is the main pathogen, in which Candida albicans has the highest infection rate;amphotericin B,cloconazole and 5-fluorocytosine have the lowest drug resistance rate,while voriconazole and itraconazole have the highest drug resistance rate.

[Key words] Deep fungal infection;Characteristics of clinical distribution;Drug resistance;Antifungal drugs

由于免疫受损群体的不断增多，真菌引起的感染日渐突出，已成为全球卫生机构共同关注的问题[1]，

国内外许多研究表明：目前真菌感染的患病率呈急剧上升的趋势，如果在早期不能获得实验室的阳性报告，临床医生用药正确率相对较低。……