2016至2018年某医院真菌血流感染者流行病学特征及耐药性分析

目的分析真菌性血流感染的病原菌分布以及耐药特征，为真菌血流感染的早期合理用药提供理论依据。 方法回顾性分析武汉大学人民医院2016年1月至2018年12月收治的真菌性血流感染者的菌群、科室分布以及耐药性。 结果入组192例真菌血流感染者的血培养样本中共分离192株真菌，其中白色念珠菌检出率为31.77%（61/192），其次热带念珠菌检出率为18.75%（36/192）；重症医学科检出率最高为33.85%（65/192）。所有菌株均对两性霉素B敏感，对其他抗菌药物耐药率分别为5-氟胞嘧啶4.49%（9/192）、伊曲康唑5.73%（11/192）、氟康唑10.94%（21/192）和伏立康唑11.46%（22/192）；除两性霉素B外，2016至2018年真菌对其他抗菌药物的耐药率均逐年上升，其中2018年所分离192株光滑念珠菌对伊曲康唑耐药菌率达46.7%。 结论真菌血流感染病原菌以念珠菌属为主，对目前抗真菌药物具有较高敏感性，但耐药率逐年上升，加强监测血培养病原菌变化及耐药趋势对指导临床用药至关重要。

Epidemiologic characteristics and drug resistance of fungal bloodstream infection in a hospital from 2016 to 2018

ObjectiveTo investigate epidemiologic characteristics and drug resistance of cases with fungal bloodstream infection, and to provide a theoretical basis for diagnosis of clinical fungal bloodstream infection and early rational drug use. MethodsThe bacterial distribution, department distribution and drug sensitivity of patients with fungal bloodstream infection from January 2016 to December 2018 in Wuhan University People’s Hospital were analyzed, retrospectively. ResultsTotal of 192 strains of fungi were isolated from blood culture-positive specimens of 192 patients, among which, Candida albicans had the highest detection rate 31.77% (61/192)], following by Candida tropicalis 18.75% (36/192)]. The department with the highest detection rate of fungal bloodstream infection was ICU 33.85% (65/192)]. All strains were sensitive to amphotericin B. The resistance rate of the other four major antibiotics were 5-fluorocytosine 4.49% (9/192)], itraconazole 5.73% (11/192)], fluconazole 10.94% (21/192)] and voriconazole 11.46% (22/192)]. Except for amphotericin B, the resistance rates of fungi to other antimicrobial agents increased year by year from 2016 to 2018, and the resistance rate of Candida smooth to itraconazole reached 46.7% in 2018. ConclusionsCandida albicans was the main pathogen of fungal bloodstream infection in our hospital. The antifungal drugs had high sensitivity, but the drug resistance rate was increasing year by year. Therefore, it was very important to strengthen monitoring of the changes of blood culture pathogens and the trend of drug resistance, which was important to guide clinical medication.