CAJ | 학술논문

目的：分析重症监护病房（ ICU）患者侵袭性真菌感染的好发部位、常见菌种及耐药性，并探讨其危险因素，为有效控制真菌感染及合理用药提供参考依据。方法对2012年1月-2013年7月入住我院ICU患者送检的各类标本进行真菌培养、菌种鉴定和真菌敏感试验。结果824例患者中发生侵袭性真菌感染108例，感染发病率为13．11％；真菌感染部位以下呼吸道最为常见，占53．04％，其次为泌尿道（31．3％）、血液（6．08％）、肠道（4．36％）等；在所分离的115株真菌中，主要为白色假丝酵母菌（46．09％）、光滑假丝酵母菌（23．48％）、无名假丝酵母菌（11．3％）及热带假丝酵母菌（10．43％）；所有分离的菌株对5-氟胞嘧啶、两性霉素B敏感，对氟康唑、伊曲康唑及伏立康唑部分耐药；长期使用广谱抗生素、机械通气、侵入性操作、低蛋白血症、激素应用等是ICU患者侵袭性真菌感染的危险因素。结论 ICU患者侵袭性真菌感染部位以下呼吸道为主，白色假丝酵母菌最为常见；临床应重视病原学检查，合理使用抗菌药物，减少不必要的侵入性操作，提高机体免疫力是预防住院患者侵袭性真菌感染的主要措施。
목적：분석중증감호병방（ ICU）환자침습성진균감염적호발부위、상견균충급내약성，병탐토기위험인소，위유효공제진균감염급합리용약제공삼고의거。방법대2012년1월-2013년7월입주아원ICU환자송검적각류표본진행진균배양、균충감정화진균민감시험。결과824례환자중발생침습성진균감염108례，감염발병솔위13．11％；진균감염부위이하호흡도최위상견，점53．04％，기차위비뇨도（31．3％）、혈액（6．08％）、장도（4．36％）등；재소분리적115주진균중，주요위백색가사효모균（46．09％）、광활가사효모균（23．48％）、무명가사효모균（11．3％）급열대가사효모균（10．43％）；소유분리적균주대5-불포밀정、량성매소B민감，대불강서、이곡강서급복립강서부분내약；장기사용엄보항생소、궤계통기、침입성조작、저단백혈증、격소응용등시ICU환자침습성진균감염적위험인소。결론 ICU환자침습성진균감염부위이하호흡도위주，백색가사효모균최위상견；림상응중시병원학검사，합리사용항균약물，감소불필요적침입성조작，제고궤체면역력시예방주원환자침습성진균감염적주요조시。
Objective To investigate the incidence features ,common pathogens and drug resistance of invasive fungal infection in the intensive care unit ( ICU) ,to explore the risk factors of invasive fungal infection ,and to provide a reference for invasive fungal infection control and rational use of antifungal drugs .Methods The samples collected from ICU patients between January 2012 and July 2013 were used for fungal culture ,identification and fungi susceptibility tests .Results Of the total 824 patients,108 (13.11%) patients developed invasive fungal infection .The major infection site was lower respiratory tract (53.04%),followed by urinary tract(31.3%), blood(6.08%),and intestinal tract(4.36%) etc.Of the totally isolated 115 strains,Candida albicans,C.glabrata,C.famata and C. tropicalis accounted for 46.09%,23.48%,11.3%and 10.43%,respectively.All the isolates were sensitive to 5-fluorocytosine(5-FC) and amphotericine B ( AMB) ,partial resistance to fluconazole ,itraconazole and voriconazole .The risk factors were usage of broad-spec-trum antibiotics ,mechanical ventilation ,invasive medical procedures ,hypoproteinemia and glucocorticoid .Conclusions The major in-fection site of invasive fungal infection was lower respiratory tract ,and Candida albicans was the main pathogen in ICU .Reasonable use of bacteriophage ,reduction of unnecessary diagnosis and treatment procedures , and improving the immune function of inpatients are main measures to prevent fungal infection .