老年住院患者临床分离真菌的分布特点与药敏分析

Distribution characteristics and drug sensitivity analysis of clinical fungi isolated from elderly inpatients

中文关键词: 真菌  念珠菌  老年  耐药性

英文关键词: fungi  candida  elderly  drug resistance

中文摘要:

      目的 探讨老年住院患者临床分离的真菌菌种分布特点及其耐药特征,为老年抗真菌感染的防控与诊疗提供参考.方法 收集2022 年1 月至12 月上海某三甲医院年龄≥60 岁、且真菌培养阳性的住院患者的临床样本、以及患者性别、年龄等临床信息,采用念珠菌筛选培养基进行分离培养,MALDI-TOF MS进行菌种鉴定,ATB FUNGUS 3 进行两性霉素B(AMB)、氟康唑(FCA)、伊曲康唑(ITR)、伏立康唑(VRC)、5-氟胞嘧啶(5FC)的体外药敏试验.结果 本研究在60～104岁住院患者中检出 1 632 株真菌,男性(997/1 632,61.09%)多于女性,70～79 岁患者最多(569/1 632,34.87%),科室来源最多为ICU(720/1 632,44.12%).检出前4 位均为念珠菌(1 596/1 632,96.38%),白念珠菌分离率最高(906/1 632,55.51%),其次为光滑念珠菌(350/1 632,21.45%)、热带念珠菌(194/1 632,11.89%)和近平滑念珠菌(123/1 632,7.54%).主要念珠菌对AMB与5FC的耐药率在0～2.86%;白念珠菌对另外3 种唑类药物的耐药率低于15%;光滑念珠菌对ITR耐药率高达42.86%;热带念珠菌对ITR耐药率最高(61.34%),对VRC和5FC耐药率均＞50%;4 种主要念珠菌的患者以男性居多,不同性别的耐药率均无统计学差异(P＞0.05).另外有247 株念珠菌对3 种唑类药物全耐药,检出比例以热带念珠菌最高(99/194,51.03%).结论 ICU应更加重视老年住院患者院内真菌感染的发生与预防.白念珠菌仍是主要分离菌种,但光滑和热带念珠菌的检出比例升高,以及对唑类药物较高的耐药率也应引起临床注意.定期的真菌药敏监测仍然是必要举措.

英文摘要:

      Objective To explore the distribution characteristics and drug resistance characteristics of fungal strains clin-ically isolated from elderly inpatients,and provide reference for the prevention,control,diagnosis andtreatment of fungal infec-tions in elderly patients.Methods The clinical samples,gender,age and other clinical information of inpatients who were≥60 years old and positive for fungal culture in a Grade Ⅲ and first-class hospital in Shanghai were collected from January to De-cember 2022.Candida screening medium was used for isolation and culture,and the strains were identified by MALDI-TOF MS.ATB FUNGUS 3 was used for in vitro drug susceptibility testing of amphotericin B(AMB),fluconazole(FCA),itra-conazole(ITR),voriconazole(VRC)and5-fluorocytosine(5FC).Results Among inpatients aged60-104,1 632 strains of fungi were isolated.with more males(997/1 632,61.09% )than females.The patients aged 70-79 had the most strains(569/1 632,34.87% ),andthefungi isolated from ICU was the most(720/1632,44.12% ).The top4 strains isolated were all Candida(1 596/1 632,96.38% ),with the highest detection rate of Candidaalbicans(906/1 632,55.51% ),followed by Candida glabrata(350/1 632,21.45% ),Candida tropicalis(194/1 632,11.89% ),and Candida parapsilosis(123/1 632,7.54% ).The resistance rate of main Candida to AMB and5FC ranged from0 to2.86% .The resistance rate of Candida albi-cans to the other three azole drugs was lower than 15% .The resistance rate of Candida glabrata to ITR was 42.86% .The re-sistance rate of Candida tropicalis to ITR was the highest(61.34% ),and the resistance rate to VRC and5FC were more than 50% .The four main types of Candida were mostly isolated from male patients,and there was no statistically significant differ-ence in drug resistance rates between different genders(P＞0.05).In addition,247 Candida strains were completely resistant to3 kinds of azole drugs,and the detection rate of Candida tropicalis was the highest(99/194,51.03% ).Conclusion ICU should pay more attention to the occurrence and prevention of nosocomial fungal infection in elderly inpatients.Candida albi-cans is still the main isolated species,but the increased detection rate of Candida glabrata and Candida tropicalis and the high resistance rate to azole drugs should also attract clinical attention.Regular surveillance on fungal susceptibility is still a necessa-ry measure.