沈秉正++++++陈志明++++++李华++++++裴小平++++++高翔++++++喻研

[摘要] 目的 探究結直肠癌术后真菌感染患者的病原菌分布、耐药性及影响因素。 方法 筛选2014年1月～2016年6月在武汉大学人民医院胃肠外科接受结直肠癌手术后真菌感染的患者46例，鉴定从患者血液、尿液、痰液和手术部位分泌物中分离出的病原真菌，分析病原真菌的分布、耐药性以及患者发生真菌感染的影响因素。 结果 分离出的病原真菌主要来源于手术部位分泌物及血液，以白色念珠菌、近平滑念珠菌、光滑念珠菌和克柔念珠菌为主，分离率分别为28.3%、21.7%、13.0%和10.9%。药敏实验结果表明，分离出的病原真菌对常用抗真菌药物均有不同程度的耐药，菌株对氟康唑、酮康唑和益康唑的耐药率较高（耐药率>20%），对5-氟胞嘧啶、两性霉素B和伏立康唑敏感（敏感率>90%）。单因素χ2检验结果表明，手术时间、年龄和基础代谢障碍是结直肠癌术后患者发生真菌感染的重要影响因素（P < 0.05）。 结论 临床医务人员需注意具有上述影响因素的患者，预防结直肠癌术后真菌感染；对于已经发生感染的患者，应根据药敏实验结果合理选用抗真菌药物。

[关键词] 结直肠癌术后；真菌感染；病原菌分布；耐药性；影响因素

[中图分类号] R969.3 [文献标识码] A [文章编号] 1673-7210（2017）06（a）-0110-04

Analysis on distribution， drug resistance， and influence factors of fungal infection after colorectal cancer operation

SHEN Bingzheng1 CHEN Zhiming1 LI Hua1 PEI Xiaoping1 GAO Xiang2 YU Yan3▲

1.Department of Pharmacy， Renmin Hospital of Wuhan University， Hubei Province， Wuhan 430060， China； 2.Department of Central Laboratory， Renmin Hospital of Wuhan Universety， Hubei Province， Wuhan 430060， China； 3.Department of Gastroenterology， Tongji Hospital， Tongji Medical College， Huazhong University of Science and Technology， Hubei Province， Wuhan 430030， China

[Abstract] Objective To explore the distribution of pathogenic fungus， drug resistance， and influence factors of fungal infection after colorectal cancer operation. Methods 46 cases of fungal infection patients in Department of Gastrointestinal Surgery after colorectal cancer operation from January 2014 to June 2016 were selected. The identification， distribution， drug resistance and influence factors of pathogenic fungus isolated form patients' blood， urine， sputum and secretions in the surgical site were analyzed. Results Pathogenic fungus isolated mainly from the secretion of surgical site and blood. The isolation rates of Candida albicans， Candida parapsilosis， Candida glabrata and Candida krusei were high， the isolation rate was 28.3%， 21.7%， 13.0% and 10.9% respectively. The results of antifungal-drug sensitive experiment showed that the pathogenic fungus displayed different degrees of resistance against antifungal drugs. Pathogenic fungus presented higher resistant rates against Fluconazole， Ketoconazole and Econazole （resistant rate more than 20%）， but sensitive against 5-fluorine cytosine， Amphotericin B and Voriconazole （sensitive rate more than 90%）. The results of single factor χ2 test showed that operation time， age， and basal metabolic disorder were the important influence factors of fungal infection after colorectal cancer operation （P < 0.05）. Conclusion Clinical medical staff should pay much more attention to patients with related influence factors and prevent fungal infection after colorectal cancer operation. If fungal infection has occurred， appropriate antifungal drugs should be selected according to the results of drug sensitive experiment.

[Key words] Postoperative colorectal cancer； Fungal infection； Distribution of pathogenic fungi； Drug resistance； Influence factors

结直肠癌是消化道常见肿瘤之一。2012年全球共有新发结直肠癌病例约136万例，新发病例数位于肺癌和乳腺癌后，居恶性肿瘤第3位。同年共有69.4万人死亡，是继肺癌、肝癌和胃癌之后全球第4高死亡率的癌症[1-2]。在整个亚洲地区，特别是中国，结直肠癌的发病率和死亡率在过去的20年里急剧上升[3-6]。手术治疗是目前最为行之有效的治疗方式之一，无论是传统的开腹治疗还是创伤较小的腹腔镜治疗，预防和治疗患者术后感染是临床医务工作者常遇到的问题。其中……