CAJ | 학술논문

目的：研究重症监护病房（ICU）患者念珠菌感染分布及耐药情况。方法采用回顾性研究方法，选择2011年1月至2013年12月浙江省嘉兴市第一医院ICU收治的危重病患者，收集送检的痰液、尿液、血液、腹水、胆汁等标本念珠菌培养呈阳性的资料，对3年来ICU念珠菌感染情况、阳性标本分布、不同念珠菌分布情况及对抗真菌药物的耐药性等进行分析。结果2011年至2013年ICU共入住患者2412例次，念珠菌感染407例（16.9%），3年间念珠菌感染率呈逐年上升趋势〔2011年至2013年念珠菌检出率分别为：13.4%（77/573）、16.1%（146/907）、19.7%（184/932）〕，差异有统计学意义（P＜0.01）。407株念珠菌来自痰液166株（占40.8%），尿液157株（占38.6%），腹水53株（占13.0%），血液13株（占3.1%），胆汁11株（占2.7%），其他7株（占1.7%）。菌属分布主要是白色念珠菌（174株）、光滑念珠菌（131株）、热带念珠菌（83株）、近平滑念珠菌（5株）、克柔念珠菌（12株）等，也检出少见的葡萄牙念珠菌和解脂念珠菌（2株）。从2011年至2013年白色念珠菌、光滑念珠菌、热带念珠菌对氟康唑、伊曲康唑、伏立康唑等抗菌药物的耐药性2013年最高，2012年最低，对两性霉素B的耐药率均为0，对伊曲康唑的耐药率最高（分别为10.9%、27.8%、9.6%），其次是伏立康唑（分别为6.6%、11.0%、0）、氟康唑（分别为4.7%、7.4%、1.9%），近平滑念珠菌、克柔念珠菌、葡萄牙念珠菌和解脂念珠菌对两性霉素B、氟康唑、伊曲康唑、伏立康唑的耐药率均为0。结论 ICU念珠菌感染率呈上升趋势，主要集中在呼吸道和泌尿道，对伊曲康唑的耐药率最高。
목적：연구중증감호병방（ICU）환자념주균감염분포급내약정황。방법채용회고성연구방법，선택2011년1월지2013년12월절강성가흥시제일의원ICU수치적위중병환자，수집송검적담액、뇨액、혈액、복수、담즙등표본념주균배양정양성적자료，대3년래ICU념주균감염정황、양성표본분포、불동념주균분포정황급대항진균약물적내약성등진행분석。결과2011년지2013년ICU공입주환자2412례차，념주균감염407례（16.9%），3년간념주균감염솔정축년상승추세〔2011년지2013년념주균검출솔분별위：13.4%（77/573）、16.1%（146/907）、19.7%（184/932）〕，차이유통계학의의（P＜0.01）。407주념주균래자담액166주（점40.8%），뇨액157주（점38.6%），복수53주（점13.0%），혈액13주（점3.1%），담즙11주（점2.7%），기타7주（점1.7%）。균속분포주요시백색념주균（174주）、광활념주균（131주）、열대념주균（83주）、근평활념주균（5주）、극유념주균（12주）등，야검출소견적포도아념주균화해지념주균（2주）。종2011년지2013년백색념주균、광활념주균、열대념주균대불강서、이곡강서、복립강서등항균약물적내약성2013년최고，2012년최저，대량성매소B적내약솔균위0，대이곡강서적내약솔최고（분별위10.9%、27.8%、9.6%），기차시복립강서（분별위6.6%、11.0%、0）、불강서（분별위4.7%、7.4%、1.9%），근평활념주균、극유념주균、포도아념주균화해지념주균대량성매소B、불강서、이곡강서、복립강서적내약솔균위0。결론 ICU념주균감염솔정상승추세，주요집중재호흡도화비뇨도，대이곡강서적내약솔최고。
Objective To study the distribution of Candida infection and drug tolerance in intensive care unit(ICU). Methods A retrospective study was conducted. The critical patients admitted from January 2011 to December 2013 in ICU of the First Hospital of Jiaxing in Zhejiang Province were enrolled,and their clinical data with positive Candida culture and drug susceptibility results in specimens of sputum,urine,blood,ascites,bile, etc were collected. In the study of these 3 years in ICU,the situation of Candida infection,the distribution of positive specimen,the condition of distribution of different strains of Candida,and the Candida tolerance to antifungal drugs were analyzed. Results From 2011 to 2013,2 412 times of patients(including one patient had admitted into ICU for more than one time)were admitted into ICU in which 407 cases were of Candida infection(16.9%),and the rate of Candida infection was rising gradually in the 3 years〔2011 to 2013 Candida positive rates were 13.4%(77/573), 16.1%(146/907),19.7%(184/932)〕,the difference being statistically significant(P<0.01). In the 407 strains of Candida,166 strains(40.8%)were isolated from sputum,157(38.6%)from urine,53 strains(13.0%)ascites, 13 strains(3.1%)blood,11 strains(2.7%)bile,7 strains(1.7%)from other specimens. The strain distribution of Candida was mainly as follows:Candida albicans(174 strains),Candida glabrata(131 strains),Candida tropicalis (83 strains),Candida parapailosis(5 strains),Candida krusei(12 strains),and 2 strains of rare Candida portugal and Lipolztica. From 2011 to 2013,the highest tolerance of Candida albicans,Candida glabrata,Candida tropicalis to fluconazole,itraconazole,Fushita Yasu and other antifungal drugs was in 2013,and the lowest was in 2012,the rates of tolerance of the above 3 strains of Candida to amphotericin B being 0,to itraconazole being the highest(10.9%, 27.8%,9.6%,respectively),to Fushita Yasu the secondary(6.6%,11.0%,0,respectively)and to fluconazole the last(4.7%,7.4%,1.9%,respectively),and the rates of tolerance of Candida parapsilosis,Candida krusei,Candida Portugal,Candida lipolztica to amphotericin B,fluconazole,itraconazole,Fushita Yasu were all 0. Conclusion In ICU,the Candida infection is mainly in the respiratory tract and urinary tract,its rate of infection has a tendency of rising,and the rate of Candida tolerance to itraconazole is the highest.