医院内侵袭性真菌感染的前瞻性研究

发布时间：2018-12-10 09:49

【摘要】：目的1、掌握我院目标人群侵袭性真菌感染的发生特征、耐药特性，探讨并分析其发生院内侵袭性真菌感染的危险因素，为侵袭性真菌感染的研究提供具有我院特点的、系统的、详细的研究资料，为临床防治策略提供客观参考依据。方法采用前瞻性对照研究方法，以2011年1月～2012年6月间入住宁夏医科大学总院的目标人群为研究对象，自入院之日起，按照统一的调查表对患者进行随访、调查。调查的内容包括：年龄、住院日、基础疾病、是否有侵入性操作、抗菌药物及抗真菌药的使用情况；以及血糖、血浆白蛋白等生化检查指标，发生侵袭性真菌感染者同时记录致病菌类型及药敏试验结果；对发生院内侵袭性真菌感染患者的原发基础疾病、标本来源、菌群分布、菌种变迁、药敏结果、所在科室的分布情况、治疗和转归进行调查并对其相关危险因素进行分析。结果入选本研究的患者共有1226例，其中有121例患者发生侵袭性真菌感染，，侵袭性真菌感染的发生率为9.87%。真菌感染部位以呼吸道感染最常见，其次是泌尿道感染。从血、尿、痰、胸腔积液、腹水、脑脊液等标本中共分离出真菌133株，其中念珠菌116株，霉菌14株，新生隐球菌3株，念珠菌中以白念珠菌(75株)最多见。真菌药敏试验结果显示抗真菌药物对真菌的敏感性有明显的种间差异。结论1、侵袭性真菌感染最常见的部位为呼吸道，其次为泌尿道，血液感染已上升至第三位；2、侵袭性真菌感染部位有从单一组织/器官向多组织/器官发展的趋势，侵袭性真菌感染变得日趋复杂化；3、白念珠菌有下降趋势，但其仍是主要致病菌，非白念株菌中的热带念珠菌已成为侵袭性真菌感染的第二位致病菌，曲霉呈逐年上升趋势，成为第三位致病菌。4、白念珠菌对5-氟胞嘧啶、氟康唑、伊曲康唑存在一定程度的耐药，而非白念珠菌则对上述三种药物存在剂量依赖性敏感；5、年龄60岁，住院天数超过30天、严重的基础疾病、高血糖、低蛋白血症及长期大量使用广谱抗生素、长期使用激素/免疫抑制剂、长期使用侵入性操作是我院侵袭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.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R519

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