摘要
目的分析四川大学华西医院住院患者侵袭性白念珠菌感染的分布情况、可能的危险因素以及真菌耐药性变化,为临床预防和合理用药提供依据。方法对四川大学华西医院2010年1月到2012年12月100例侵袭性白念珠菌感染患者的临床资料进行回顾性分析,分析并总结其标本来源、科室分布、年龄分布、感染的危险因素、抗菌药物使用情况以及真菌耐药率的变迁。结果在侵袭性白念珠菌感染中,血流感染最为多见,占55%,感染患者多为ICU重症患者,占35%。年龄分布中位数为53.5岁。可能相关危险因素中外科手术和气管插管/切开、机械通气分别占74.6%和46.5%,有94例(82.5%)使用过抗菌药物。3年来我院白念珠菌对氟康唑、伏立康唑、两性霉素B耐药率为0%,对5-氟胞嘧啶和伊曲康唑的耐药率分别保持在4.1%和27.7%以下。结论白念珠菌是ICU重症患者的血流侵袭性真菌感染中重要的病原菌,外科手术和气管插管/切开及呼吸机的使用是最显著侵袭性白念感染的两大危险因素。虽然目前临床常用抗真菌药物能覆盖侵袭性白念珠菌的治疗,但仍应加强对重点科室以及有相关危险因素患者的监测,重视培养鉴定与药敏结果对临床用药的指导,以减少耐药菌的出现与流行。
Objective To analyze the distribution and risk factors of invasive Candida albicans infections and the dynamic variation of antifungal resistance in inpatients of West China hospital in order to provide information of prevention and use of antifungal agents in clinical practice. Methods Clinical data from inpatients of West China hospital from Jan 2010 to Dec 2012 were analyzed retrospectively. The specimen types, departments, factors, median age of the patients, usage of antifungal agents and the dynamic variation of antifungal resistance were reviewed and analyzed. Result Blood was the most common specimen, accounting for 55%. Most of Candida albicans （35%） isolated from ICU patients. The median age was 53.5.The probability of infected invasive Candida albicans rose obviously in patients with surgical operation and tracheotomy tube/mechanical ventilation, accounting for 74.6%, 46.5%, respectively. Ninety-four cases（82.5% ） used antimicrobial drugs before Candida albicans recovered. In three years the drug-resistant rate of Candida albicans to fluconazole, voriconazole and amphotericin B remained 0 and 5-fluorocytosine and Itraconazole remained below 4.1% and 27.7%. Conclusion The most common department with Candida albicans infection was ICU. Surgical operation and tracheotomy tube/mechanical ventilation/using a ventilator were two most significant possible risk factors. Common departments and patients with risk factors monitoring system should be strengthened, and results of culture and susceptibility tests should be paid more attention to guide the reasonable use of antifungal agents in clinic.
出处
《中国抗生素杂志》
CAS
CSCD
北大核心
2014年第10期780-784,共5页
Chinese Journal of Antibiotics
基金
四川省科技厅科技支撑项目(2011SZ0125)
关键词
白念珠菌
无菌体液
风险因素
耐药性变迁
Candida albicans
Sterile body fluids
Possible risk factors
Antifungal agents
