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目的探讨ICU中心静脉置管相关性血流真菌感染临床易感因素和真菌耐药性,以提高临床诊治水平。方法回顾性分析2010年1月-2013年1月65例ICU中心静脉置管相关性血流感染患者临床资料,对其中出现真菌感染进行危险因素和病原菌耐药性分析。结果 ICU中心静脉置管相关性血流真菌感染13例,感染率为35.38%;共分离出真菌39株,其中热带假丝酵母菌所占比例最高,占33.33%;热带假丝酵母菌和近平滑假丝酵母菌对两性霉素B耐药率较低,分别为7.69%和11.11%,白色假丝酵母菌对氟胞嘧啶耐药率较低,为10.0%,光滑假丝酵母菌对酮康唑耐药率为0;中心静脉插管时间长(>14d)、低蛋白血症、多个静脉导管接头(>3个)、多根留置体腔内引流(>4根)、联合使用抗菌药物时间长(>7d)、伴有其他部位感染、肠外营养时间长(>7d)、病情严重(评分为4~5分)是ICU中心静脉置管相关性血流真菌感染的危险因素(P<0.05)。结论 ICU中心静脉置管相关性血流真菌感染与置管时间等因素密切相关,加大干预后可降低感染的发生。
Objective To investigate the clinical susceptibility factors and fungal drug resistance of central venous catheter-associated bloodstream fungal infections in ICU to improve the clinical diagnosis and treatment. Methods The clinical data of 65 ICU patients with ICU-related bloodstream infections from January 2010 to January 2013 were retrospectively analyzed. The risk factors and pathogenic resistance of fungal infections were analyzed. Results Thirteen cases of ICU central venous catheter-related bloodstream fungal infection were infected with the infection rate of 35.38%. A total of 39 fungi were isolated, of which Candida tropicalis accounted for the highest proportion (33.33%). Candida tropicalis Candida albicans resistance rate to amphotericin B was low, respectively 7.69% and 11.11%, Candida albicans resistance to flucytosine was low, 10.0%, Candida glabrata ketone The antibiotic resistance rate was 0; central venous catheterization for a long time (> 14 days), hypoproteinemia, multiple venous catheters (> 3), multiple indwelling drainage (> 4) Prolonged periods of medication (> 7 days) with other infections, prolonged parenteral nutrition (> 7 days), and serious illness (score 4 to 5) are risk factors for central venous catheter-associated bloodstream fungal infections in the ICU P <0.05). Conclusion ICU central venous catheter-related bloodstream fungal infection and catheterization time and other factors are closely related to increase the intervention can reduce the incidence of infection.