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目的探讨笔者所在医院重症监护病房(ICU)患者深部真菌感染的发病特点,并了解院内深部真菌感染常见致病菌的耐药情况。初步探讨院内深部真菌感染高危因素,对相关因素进行分析,为有效控制真菌感染及合理用药提供参考依据。方法采用前瞻性对照研究,对2011年1月～2012年6月入住ICU经筛选符合条件的231例患者作为研究对象,随访和调查患者的性别、年龄、住院时间、基础疾病,是否有侵入性操作、使用抗真菌药物情况,以及部分血生化检查指标,同时记录真菌感染者致病菌种及药敏试验结果。结果 231例患者中真菌感染者37例,深部真菌的发病率为16.02%。真菌感染部位以下呼吸道感染最为常见。从血液、尿液、痰液、胸腔积液、腹水、脑脊液等标本中共分离出菌株45株,其中酵母菌42株,霉菌3株,酵母菌中以白念珠菌(18株)最为多见。真菌培养药敏试验结果显示抗真菌药物对深部真菌的敏感性分布有明显的种间差异。结论①深部真菌感染以白念珠菌最为常见,其次是热带念珠菌、光滑念珠菌、曲霉。真菌感染部位以下呼吸道感染最为常见。药敏试验结果显示,抗真菌药物对深部真菌的敏感性分布有明显的种间差异。②高龄、住院时间长、抗菌药物的广泛应用、各种侵入性操作的使用、高血糖、低蛋白血症、贫血是ICU患者深部真菌感染的高危因素。
Objective To investigate the incidence of deep fungal infection in intensive care unit (ICU) patients in our hospital and to understand the drug resistance of common pathogens in deep fungal infections in the hospital. Preliminary study of hospital risk factors for deep fungal infection, the analysis of the relevant factors for the effective control of fungal infections and rational use of drugs provide a reference. Methods A prospective controlled study was conducted in 231 eligible ICU patients admitted to ICU from January 2011 to June 2012. All patients were followed up and investigated for gender, age, hospital stay, underlying disease, and invasiveness Operation, the use of antifungal drugs, as well as some blood biochemical tests, and record the fungal pathogens and susceptibility test results. Results Among the 231 patients, 37 were fungal infections, the incidence of deep fungi was 16.02%. The most common respiratory infections following fungal infection. 45 strains were isolated from blood, urine, sputum, pleural effusion, ascites, cerebrospinal fluid and other specimens, of which 42 yeast strains, 3 molds, and Candida albicans (18 strains) were the most common in yeast. The results of fungal culture susceptibility tests showed that the antifungal agents have obvious interspecific differences in the distribution of sensitivity to deep fungi. Conclusion ① Candida albicans is most common in deep fungal infections, followed by Candida tropicalis, Candida glabrata and Aspergillus. The most common respiratory infections following fungal infection. Susceptibility test results show that the antifungal drug sensitivity distribution of deep fungi have obvious differences between species. ② elderly, hospitalization for a long time, the widespread use of antimicrobial agents, the use of a variety of invasive procedures, hyperglycemia, hypoproteinemia, anemia is a high risk factor for deep fungal infection in ICU patients.