深部真菌的感染特点及耐药分析[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ATBFungus2真菌药敏板条，用ATBExpression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[]R379#8195;#8195;#8195;[文献标识码]B#8195;#8195;#8195;[]2095-0616（2014）08-52-04AnanalysisofcharacteristicsanddrugresistanceofdeepfungalinfectionZHAO#8195;Hui1#8195;#8195;WANG#8195;Qun1#8195;#8195;ZHAO#8195;Bing1#8195;#8195;WANG#8195;Ning2#8195;#8195;XUE#8195;Hong11.DepartmentofClinicalLaboratory,theSecondAffiliatedHospitalofShenyangMedicalCollege,Shenyang110001,China;2.DepartmentofClinicalLaboratory,AffiliatedCentralHospitalofShenyangMedicalCollege,Shenyang110024,China[Abstract]ObjectiveTounderstandthecharacteristicsofclinicaldistributionanddrugresistanceofdeepfungalinfection,soastoguideappropriateclinicalapplicationofantifungaldrugs.Methods426deepsamples(sputum,urine,excrement,blood,cerebrospinalfluid,genitalsecretionsandwoundsecretions)fromclinicalpatientsinourhospitalwerecollectedandculturedinSabourand'smediumandchromogenicmediausedtoidentifybacterialstrains.TheisolatedstrainswerethenculturedinanantifungalsusceptibilitystripofATBFungus2producedbythebioMérieuxGroup,andminimuminhibitoryconcentrationwasobtainedviaanidentificationinstrumentofATBExpression.Thedrugsusceptibilityregardingclinicallycommonlyseenfungusagainstantifungaldrugswasobtained.Results167deepfungalinfectionsweredetected.Thedetectionrateofinfectedfungalsamplesinsputumwas63.5%,thehighestone.Thesecondhighestratewasinurine,accountingfor15.6%.Among167strainsoffungus,160strainsbelongedtoCandidainfection,inwhichthemajoritywasCandidaalbicans(67.1%,112/167).Indepartments,thehighestinfectionrateof41.9%wasseeninthedepartmentofelderlyofficials;thesecondinfectionrateof26.3%wasseeninthedepartmentofpneumology.123patientswereolderthen60yearsofage,accountingfor73.6%.ThedrugresistanceofgenusCandidawasrelativelyhighagainstvoriconazoleanditraconazole,accountingfor75.05%and51.10%respectively.Itsdrugresistancewasrelativelylowagainst5-fluorocytosineandamphotericinB,accountingfor2.20%and2.90%respectively.ConclusionElderlypatientstendtobeinfectedwithdeepfungus,andthemaininfectedpositionisrespiratorytract.GenusCandidaisthemainpathogen,inwhichCandidaalbicanshasthehighestinfectionrate;amphotericinB,cloconazoleand5-fluorocytosinehavethelowestdrugresistancerate,whilevoriconazoleanditraconazolehavethehighestdrugresistancerate.[Keywords]Deepfungalinfection;Characteristicsofclinicaldistribution;Drugresistance;Antifungaldrugs由于免疫受损群体的不断...