重症监护病房真菌谱及耐药性6年变化趋势

中国真菌学杂志　 2014, Vol. 9 　Issue (1): 24-27,33.

重症监护病房真菌谱及耐药性6年变化趋势

张伟¹, 林兆奋¹, 赵瑾², 许诗琼³, 单红卫¹

1. 上海长征医院急救科, 上海 200003;
2. 上海长征医院皮肤病与真菌病研究所全军真菌病重点实验室第二军医大学附属长征医院皮肤科, 上海 200003;
3. 上海第九人民医院眼科, 上海 200011

收稿日期:2013-12-23 出版日期:2014-02-28 发布日期:2014-02-28
通讯作者: 单红卫，E-mail：shwshan@163.com E-mail:shwshan@163.com
作者简介:张伟，男（汉族），住院医师.E-mail：zhangwei_8@sina.com

Trends of fungal spectrum and drug resistance changes in Intensive Care Unit

ZHANG Wei¹, LIN Zhao-fen¹, ZHAO Jin², XU Shi-qiong³, SHAN Hong-wei¹

1. Critical Care and Emergency Department, Shanghai Changzheng Hospital, Shanghai 200003, China;
2. Institute of dermatology and fungal disease, Key Laboratory of the army fungal disease, Department of dermatology, Changzheng Hospital, Shanghai 200003, China;
3. Ophthalmology Department, Shanghai Ninth Peoples Hospital, Shanghai 200011, China

Received:2013-12-23 Online:2014-02-28 Published:2014-02-28

摘要/Abstract

摘要： 目的调查我院重症监护室（ICU）近6 a临床分离真菌株的菌种结构及耐药性变化。方法 2007~2012年从我院1 435例ICU患者中分离出的1 435株真菌均为首次分离的菌株。采用Cox-Stuart趋势检验回顾性分析了分离真菌株的菌种结构和主要真菌对常用抗真菌药物耐药率的变化趋势。结果 2007~2012年间，我院ICU真菌检出阳性标本总数从159株/a逐年增加至396株/a。其中，白念珠菌、近平滑念珠菌、曲霉的构成比波动范围分别为34.6%~50.3%、6.3%~9.6%、1.3%~3.2%，2010~2012年较2007~2009年构成比总体均有上升趋势，P=0.02。热带念珠菌、光滑念珠菌、克柔念珠菌构成比波动范围分别为13.6%~17.3%、9.4%~22.6%、1.4%~5.2%，P=0.18，构成比均无明显上升或下降趋势。2010~2012年较2007~2009年，白念珠菌对氟康唑和伊曲康唑耐药率的变化均呈降低趋势，P=0.02。热带念珠菌对氟康唑和伊曲康唑耐药率的变化均呈降低趋势，P=0.02；光滑念珠菌对伊曲康唑耐药率的变化总体呈上升趋势，P=0.02。结论我院ICU近6 a来白念珠菌仍然为临床最常见的真菌分离株，白念珠菌、近平滑念珠菌及曲霉占总真菌分离株的百分比有上升趋势。白念珠菌及热带念珠菌对氟康唑和伊曲康唑耐药率均呈降低趋势，光滑念珠菌对伊曲康唑耐药率呈上升趋势。

关键词: 重症监护病房, 真菌谱, 耐药率, 变化趋势

Abstract: Objective To investigate the trends of fungal spectrum and drug resistance changes in Intensive Care Unit in six years.Methods One-thousand four hundred and thirty five stains of first-time isolated fungi were isolated during 2007-2012 in ChangZheng Hospital Intensive Care Unit. Cox-Stuart test was used to analysis trends in distribution of fungi and drug resistance changes in this retrospective study.Results During 2007-2012, the number of fungi inspected increased from 159 to 396 strains per year, among which the ratio of Candida albican,parapsilosis,aspergillus ranging 34.6%-50.3%,6.3%-9.6%,1.3%-3.2% with a trend of increase,P=0.02;Candida tropicalis,glabrata,and krusei ranging 13.6%-17.3%,9.4%-22.6%,1.4%-5.2%,P=0.18;The average drug resistant of Candida albican to itraconazole and fluconazole showed a trend of decrease P=0.02;The average drug resistant of Candida tropicalis to itraconazole and fluconazole showed a decreased trend as well,P=0.02 whereas the average drug resistant of Candida glabrata to itraconazoleshowed an increased trend,P=0.02.Conclusion The most common isolated strains of fungi in ICU were Candida albican,followed by Candida tropicalis and Candida glabrata.Candida albican,Candida parapsilosis and Aspergillus had increase ratio of distribution.There are decrease trends in the drug resistance of Candida albican and Candida tropicalis to fluconazole and itraconazole whereas Candida glabrata showed a increase trend to itraconazole.

Key words: Intensive Care Unit, fungal spectrum, drug resistance, trend

中图分类号:

张伟, 林兆奋, 赵瑾, 许诗琼, 单红卫. 重症监护病房真菌谱及耐药性6年变化趋势[J]. 中国真菌学杂志, 2014, 9(1): 24-27,33.

ZHANG Wei, LIN Zhao-fen, ZHAO Jin, XU Shi-qiong, SHAN Hong-wei. Trends of fungal spectrum and drug resistance changes in Intensive Care Unit[J]. Chinese Journal of Mycology, 2014, 9(1): 24-27,33.

参考文献

[1] Bassetti M, Ansaldi F, Nicolini L, et al. Incidence of candidaemia and relationship with fluconazole use in an intensive care unit[J]. J Antimicrob Chemother, 2009, 64(3):625-629.
[2] Hope W, Morton A, Elsen DP. Increase in prevalence of nosocomial non-Candida albicans candidaemia and the association of Candida krusei with fluconazole use[J]. J Hosp Infect, 2002,5(10):56-65.
[3] Rubio PM, Sevilla J, González-Vicent M, et al. Increasing incidence of invsiveaspergillosis in pediatric hematology oncology patients over the last decade:a retrospective single centre study[J]. J Pediatr Hematol Oncol, 2009, 31(9):642-646.
[4] 居学丰,张伟,吴晓,等.重症监护病房白念珠菌耐药性8年变化趋势[J].中国真菌学杂志,2012,07(3):150-152.
[5] Pfaller MA, Diekema DJ, Gibbs DL, et al. Results from the ARTEMIS DISK Global Antifungal Surveillance study, 1997 to 2005: an 8.5-year analysis of susceptibilities of Candida species and other yeast species to fluconazole and voriconazole determined by CLSI standardized disk diffusion testing[J]. J Clin Microbiol,2007, 45(6):1735-1745.
[6] 李华信,高春芳,李晓冰,等. 医院深部真菌感染900例病原菌分布及耐药性监测[J].中华医院感染学杂志,2010,20(13):1980-1983.
[7] 付祖姣,禹凯琼,李红卫,等. 435株真菌的临床分布及药敏分析[J].实用预防医学,2011,18(11):2184-2186.
[8] 肖翔林,杨新云,苏丹红等.血液病区抗菌药物用量与大肠埃希氏菌耐药的相关性分析[J].今日药学, 2008,18(5):34-35.
[9] Bowyer P, Moore CB, Rautemaa R,et al. Azole antifungal resistance today: focus on Aspergillus [J].Curr Infect Dis Rep,2011;13(6):485-491.
[10] Hidron AI, Edwards JR, Patel J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007[J]. Infect Control Hosp Epidemiol,2008,29(11):996-1011.
[11] Li L, Redding S, Dongari-Bagtzoglou A.Candida glabrata:an emerging oral opportunistic pathogen[J]. J Dent Res,2007,86(3): 204-215.
[12] Eggimann P, Garbina J, Pittet D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Infections in critically ill non-immunosuppressed patients[J]. Lancet Infect Dis,2008,3(2):685-702.
[13] Arendrup MC, Fisher BT, Zaoutis TE. Invasive fungal infections in the paediatric and neonatal population: diagnostics and management issues[J].Clin Microbiol Infect,2009,15(7):613-624.
[14] 詹燏,汤贝贝,刘水逸,等.临床标本中假丝酵母菌属的检出率及耐药性分析[J].中华医院感染学杂志,2012,22(3):645-646.
[15] 中国侵袭性真菌感染工作组.血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(第三次修订)[J].中华内科杂志,2010,49(5):451-454.
[16] Cornely A,Bassetti M,Calandra T,et al.ESCMID guideline for the diagnosis and management of Candida diseases 2012:non-neutropenic adult patients [J].Clin Microbiol Infect, 2012,18(Suppl 7):19-37.
[17] Chau AS, Mendrick CA, Sabatelli FJ, et al.Application of real-time quantitative PCR to molecular analysis of Candida albicans strains exhibiting reduced susceptibility to azoles[J]. Antimicrob Agents Chemother,2004,48(6):2124-2131.