重症监护病房白念珠菌耐药性8年变化趋势

目的调查上海长征医院重症监护室(ICU)近8 a中临床分离白念珠菌的耐药性变化,为临床治疗提供参考。方法上海长征医院ICU 2002～2009年从414例患者中首次分离出414株白念珠菌,对其中277株进行药敏试验。采用Cox-Stuart趋势检验回顾性分析临床分离真菌中白念珠菌所占比例变化趋势和白念珠菌对常用抗真菌药物耐药率的变化趋势。结果 2002～2009年间,上海长征医院ICU白念珠菌分离株数从2002年的34株增加至2009年的92株,但白念珠菌占总真菌分离株数的百分比维持在34.6%～55.7%,P=0.03。白念珠菌对于5-氟胞嘧啶和两性霉素B平均耐药率分别为4.0%和0.7%,对其他常用抗真菌药的耐药率依次为咪康唑47.0%、酮康唑10.8%、伊曲康唑19.9%、特比萘芬42.6%、氟康唑14.6%及伏立康唑13.0%。白念珠菌对5-氟胞嘧啶和两性霉素B和伊曲康唑耐药率的8年变化无统计学差异。结论上海长征医院ICU近8 a来白念珠菌仍然为临床较为常见的真菌分离株,但白念珠菌占总分离株数的百分比有逐渐减少的趋势。白念珠菌对常用抗真菌药物耐药性均无明显变化趋势。

Trend of drug resistance in clinical Candida albicans isolates from intensive care unit in Changzheng Hospital,2002-2009

Objective To investigate an eight-year resistance change of clinically isolated Candida albicans strains in intensive care unit （ICU） in our hospital and to provide a reference for clinical diagnosis and treatment.Methods Four hundred and fourteen Candida albicans strains were isolated from 414 cases in ICU during 2002-2009. Among those isolates, 277 strains were performed sensitivity tests. Cox-Stuart trend test was used to analyze the change of Candida albicans proportion in whole isolated fungi and their resistance to commonly used antifungal angents.Results The Candida albicans isolates increased from 34 in 2002 to 92 in 2009, while their proportions in whole isolated fungi ranged from 34.6% to 55.7% （P=0.03）. Average resistance rates of Candida albicans to antifungal angents were 5-fluorocytosine 4.0%, amphotericin B 0.7%, miconazole 47.0%, ketoconazole 10.8%, itraconazole 19.9%, terbinafine 42.6%, fluorocytosine 14.6% and voriconazole 13.0%, respectively. No significant changes of Candida albicans resistance to 5-fluorocytosine, amphotericin B and itraconazole in 8 years were detected （P=0.06,P=0.06,P=0.31 respectively）.Conclusions The recent eight-year data shows Candida albicans still remains to be the commonest clinical fungal isolate in ICU in Changzheng Hospital,though its proportion in whole fungal isolates being in trend of decrease, and its resistant rate to commonly used antifungal agents having not changed significantly.