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目的普通外科深部非白色念珠菌感染的发生的病原真菌的种类,易患因素、耐药情况及防治。方法回顾性分析2004年3月—2008年6月间郑州大学第一附属医院普通外科收治的31例非白色念珠菌病人的易感因素、病原学种类特点、耐药情况及治疗措施。结果易感因素主要为使用广谱抗生素、中心静脉插管、全胃肠外营养、高龄、大型手术、入住重症监护病房等。31例病人分离出40例菌株,同一患者可培养出不同菌株。非白色念珠菌的主要致病真菌是热带念珠菌、葡萄牙念珠菌、克柔念珠菌、光滑念珠菌,大部分对氟康唑耐药。31例经抗真菌治疗者中8例死亡,病死率25.81%。结论非白念感染感染多发生多存在宿主因素,菌株以热带念珠菌、葡萄牙念珠菌为主,大部分对氟康唑耐药,部分对伊曲康唑耐药。对高危病人应重视病原学检查及药物敏感性测定,消除易感因素,及时合理选用抗真菌药物和加强支持治疗,有望进一步改善预后。
Objective To investigate the types, risk factors, drug resistance and control of pathogenic fungi in non-Candida albicans infection in general surgery. Methods The clinical data of 31 non-Candida albicans patients admitted to the First Affiliated Hospital of Zhengzhou University from March 2004 to June 2008 were retrospectively analyzed for their susceptibility, etiological characteristics, drug resistance and treatment. Results The main predisposing factors were the use of broad-spectrum antibiotics, central venous catheterization, total parenteral nutrition, advanced age, major surgery, intensive care unit and so on. Forty patients were isolated from 31 patients, and different strains could be cultivated in the same patient. The main pathogenic fungi of Candida albicans are Candida tropicalis, Candida glabrata, Candida krusei, Candida glabrata, and most of them are resistant to fluconazole. Among the 31 patients treated with antifungal therapy, 8 died, with a mortality rate of 25.81%. CONCLUSION: Non-albino infection has many host factors. The strains are mainly Candida tropicalis and Candida glabrata. Most of them are resistant to fluconazole and partly to itraconazole. High-risk patients should pay attention to the etiological examination and determination of drug sensitivity, elimination of susceptibility factors, the timely and rational use of anti-fungal drugs and supportive care is expected to further improve the prognosis.