【摘要】：目的1、掌握我院目標(biāo)人群侵襲性真菌感染的發(fā)生特征、耐藥特性，探討并分析其發(fā)生院內(nèi)侵襲性真菌感染的危險(xiǎn)因素，為侵襲性真菌感染的研究提供具有我院特點(diǎn)的、系統(tǒng)的、詳細(xì)的研究資料，為臨床防治策略提供客觀參考依據(jù)。 方法采用前瞻性對(duì)照研究方法，以2011年1月～2012年6月間入住寧夏醫(yī)科大學(xué)總院的目標(biāo)人群為研究對(duì)象，自入院之日起，按照統(tǒng)一的調(diào)查表對(duì)患者進(jìn)行隨訪、調(diào)查。調(diào)查的內(nèi)容包括：年齡、住院日、基礎(chǔ)疾病、是否有侵入性操作、抗菌藥物及抗真菌藥的使用情況；以及血糖、血漿白蛋白等生化檢查指標(biāo)，發(fā)生侵襲性真菌感染者同時(shí)記錄致病菌類型及藥敏試驗(yàn)結(jié)果；對(duì)發(fā)生院內(nèi)侵襲性真菌感染患者的原發(fā)基礎(chǔ)疾病、標(biāo)本來(lái)源、菌群分布、菌種變遷、藥敏結(jié)果、所在科室的分布情況、治療和轉(zhuǎn)歸進(jìn)行調(diào)查并對(duì)其相關(guān)危險(xiǎn)因素進(jìn)行分析。 結(jié)果入選本研究的患者共有1226例，其中有121例患者發(fā)生侵襲性真菌感染，，侵襲性真菌感染的發(fā)生率為9.87%。真菌感染部位以呼吸道感染最常見(jiàn)，其次是泌尿道感染。從血、尿、痰、胸腔積液、腹水、腦脊液等標(biāo)本中共分離出真菌133株，其中念珠菌116株，霉菌14株，新生隱球菌3株，念珠菌中以白念珠菌(75株)最多見(jiàn)。真菌藥敏試驗(yàn)結(jié)果顯示抗真菌藥物對(duì)真菌的敏感性有明顯的種間差異。 結(jié)論1、侵襲性真菌感染最常見(jiàn)的部位為呼吸道，其次為泌尿道，血液感染已上升至第三位；2、侵襲性真菌感染部位有從單一組織/器官向多組織/器官發(fā)展的趨勢(shì)，侵襲性真菌感染變得日趨復(fù)雜化；3、白念珠菌有下降趨勢(shì)，但其仍是主要致病菌，非白念株菌中的熱帶念珠菌已成為侵襲性真菌感染的第二位致病菌，曲霉呈逐年上升趨勢(shì)，成為第三位致病菌。4、白念珠菌對(duì)5-氟胞嘧啶、氟康唑、伊曲康唑存在一定程度的耐藥，而非白念珠菌則對(duì)上述三種藥物存在劑量依賴性敏感；5、年齡60歲，住院天數(shù)超過(guò)30天、嚴(yán)重的基礎(chǔ)疾病、高血糖、低蛋白血癥及長(zhǎng)期大量使用廣譜抗生素、長(zhǎng)期使用激素/免疫抑制劑、長(zhǎng)期使用侵入性操作是我院侵襲性真菌感染的高危因素。
[Abstract]:Objective 1. To understand the characteristics of invasive fungal infection and drug resistance in the target population in our hospital, and to explore and analyze the risk factors of invasive fungal infection in hospital, so as to provide the characteristic for the study of invasive fungal infection in our hospital. Systematic and detailed research data provide objective reference for clinical prevention and treatment strategy. Methods A prospective controlled study was conducted with the target population admitted to the General Hospital of Ningxia Medical University from January 2011 to June 2012. The patients were followed up according to a unified questionnaire from the date of admission. The survey included age, length of stay, underlying diseases, invasive practices, use of antimicrobial agents and antifungal agents; Blood glucose, plasma albumin and other biochemical indicators, invasive fungal infection at the same time recorded the types of pathogens and drug sensitivity test results; The primary basic diseases, specimen sources, microflora distribution, bacterial species changes, drug susceptibility results, distribution, treatment and outcome of the patients with nosocomial invasive fungal infection were investigated and the related risk factors were analyzed. Results A total of 1226 patients were enrolled in this study, including 121 patients with invasive fungal infection, the incidence of invasive fungal infection was 9.87. Respiratory tract infection was the most common site of fungal infection, followed by urinary tract infection. 133 strains of fungi were isolated from blood, urine, sputum, pleural effusion, ascites and cerebrospinal fluid. Among them, 116 strains of candida, 14 strains of mold, 3 strains of Cryptococcus neoformans, and 75 strains of Candida albicans were the most common. The results of fungal susceptibility test showed that the sensitivity of antifungal drugs to fungi was significantly different. Conclusion 1.Respiratory tract is the most common site of invasive fungal infection, followed by urinary tract, blood infection has risen to the third place; (2) the invasive fungal infection tends to develop from single tissue / organ to multiple tissue / organ, and the invasive fungal infection becomes more and more complicated. 3, Candida albicans has a downward trend, but it is still the main pathogenic bacteria. Candida tropicalis in non-Candida albicans has become the second leading pathogen of invasive fungal infection, and Aspergillus albicans has been increasing year by year, becoming the third pathogenic bacteria. Candida albicans were resistant to 5-fluorocytosine, fluconazole and itraconazole to some extent, while non-Candida albicans were sensitive to these three drugs in a dose-dependent manner. 5, age 60 years, hospital stay longer than 30 days, severe underlying diseases, hyperglycemia, hypoproteinemia, long-term extensive use of broad-spectrum antibiotics, long-term use of hormones / immunosuppressants, Long-term invasive operation is a high risk factor for invasive fungal infection in our hospital.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R519

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