血流感染假丝酵母菌菌种构成及其药物敏感性

Constitute and antifungal susceptibility of Candida spp. causing bloodstream infection

摘要:

目的分析某院假丝酵母菌血流感染菌种构成及其对抗真菌药物的敏感性，为临床预防和治疗假丝酵母菌血流感染提供依据。方法回顾性分析2009—2013年该院临床科室送检血标本中检出的假丝酵母菌，并对假丝酵母菌血流感染的高危因素进行分析。结果2009—2013年42例患者血标本分离假丝酵母菌42株，以近平滑假丝酵母菌为主（20株，47.62%），其次为白假丝酵母菌（16株，38.10%）、热带假丝酵母菌（4株，9.52%）、光滑假丝酵母菌（2株，4.76%）。来源科室主要为：急诊监护病房（EICU，11株）、泌尿外科（9株）、心胸外科（8株）等。37例（占88.10%）患者静脉导管与血标本培养出相同的假丝酵母菌，留置静脉导管至血培养阳性和导管培养阳性的平均时间分别为31.47 d和33.18 d；导管和血培养阳性比例随着置管时间的延长均呈上升趋势（均P＜0.001）。检出的假丝酵母菌对氟康唑、伏立康唑的敏感率均为75.00%～100.00%，对两性霉素B的敏感率均为100.00%；而不同菌种对伊曲康唑的敏感率存在较大差异（0～87.50%）。结论该院假丝酵母菌血流感染菌株以近平滑假丝酵母菌为主，且与静脉导管的使用有关，其对氟康唑、两性霉素B、伏立康唑的敏感性均较高。

Abstract:

ObjectiveTo analyze the constitute and antifungal susceptibility of Candida spp. causing bloodstream infection in a hospital, so as to provide evidence for the prevention and treatment of bloodstream infection caused by Candida spp.MethodsCandida spp. isolated from blood specimens of clinical patients in a hospital between 2009 and 2013 were analyzed retrospectively, the high risk factors for Candida bloodstream infection were analyzed.ResultsA total of 42 isolates of Candida spp. were isolated from blood specimens of 42 patients between 2009 and 2013, the major was Candida parapsilosis (C. parapsilosis, n=20,47.62%), followed by C.albicans (n=16,38.10%), C.tropicalis (n=4, 9.52%), and C.glabrata(n=2, 4.76%). Candida spp. were mainly distributed in emergency intensive care unit(n=11), departments of urologic surgery (n=9) and cardiothoracic surgery(n=8). The venous catheters of 37 patients(88.10%) were isolated the same Candida spp. as blood culture, the average time from indwelling venous catheters to positive culture of blood and catheters were 31.47 and 33.18 days respectively; the percentage of positive culture for blood and catheters both increased with the prolongation of catheterization (both P<0.001). Susceptibility rates of Candida spp. to fluconazole and voriconazole were 75.00%-100.00%, to amphotericin B were all 100.00%, to itraconazole varied significantly with different species (0-87.50%).ConclusionThe major Candida strains causing bloodstream infection in this hospital is C. parapsilosis, and is related to the use of intravenous catheters, susceptibility rates to fluconazole, amphotericin B, and voriconazole are all high.