血流感染真菌的分布及耐药性分析

目的了解真菌性血液感染常见病原真茵的菌群分布及耐药性状况，为临床真菌感染性疾病提供病原学诊断和合理使用抗真菌药物的依据。方法回顾性分析浙江大学医学院附属第一医院5年（2008-2012年）间导致真菌性血液感染的217株真菌的菌群分布及药物敏感性状况。结果217株真菌标本中以假丝酵母菌属为主，占88. 5%;其中又以白假丝酵母菌比例最高，占35.4%。菌种分布与患者的性别和年龄存在相关性。60-79岁年龄组感染白假丝酵母菌多见，占49% ,这一比例明显高于其他真菌。男性更容易感染白假丝酵母菌（40.1% vs 24.6%，P〈0.05），女性感染近平滑假丝酵母菌更常见（24.6% vs 11.8%,P〈0.05）.假丝酵母菌和新生隐球菌对两性霉素B、伏立康唑、氟康唑、伊曲康唑、5-氟胞嘧啶的敏感性均较高。光滑假丝酵母菌对伊曲康唑敏感率较低，仅为60.0%。结论真菌血流感染在临床呈上升趋势，抗真菌药物均体现较高抗菌活性，对真菌感染进行地区层面流行病学调查和耐药监测很重要。

Species distribution and drug resistance of bloodstream isolates of fungi

Objective To investigate the distribution and drug resistance of fungi isolated from blood specimens of bloodstream infection ,and to provide the evidence to clinical treatment. Methods 217 strains of fungi isolated from blood specimens in The First Hospital Affiliated Zhejiang University during the period of 2008-2012 were retrospectively reviewed. Results Candida accounted for 88. 5%of the pathogens, and Candida albicans （35.4% ） was predominant. The species distribution varied significantly by both age and gender. The proportion of candidemias caused by Candida albicans was higher among 60-79 year old. Candida albicans was more common in malesthan females （40.1% vs 24. 6%,P 〈0. 05） , whereas C. parapsilosis was more common in females （ 24. 6% vs 11.8%,P 〈 0. 05 ）. Overall, Candida and cryptococcus neoformans were susceptible to 5 antifungal drugs basically. However, only 60. 0% of C. glabrata isolates were sensitive to itraconazole. Conclusion The result of susceptibility test show that the fungi aregood susceptibe to antifungaldrugs. It is imperative to promote a regional-level surveillance program to monitor this important microorganism.