Zhang C, Gong Y L, Luo X Q, Liu M X, Shi Y L, Liu T F, Li H Y, Peng Y Z
State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400038, China.
Zhonghua Shao Shang Za Zhi. 2020 Jan 20;36(1):37-41. doi: 10.3760/cma.j.issn.1009-2587.2020.01.007.
To retrospectively analyze the diagnosis time, pathogen distribution, and drug resistance of fungal bloodstream infection in severe burn patients. Blood samples were collected from 55 severe burn patients with fungal bloodstream infection (including 46 males and 9 females, aged 42 (1, 78) years) admitted to the intensive care unit of the Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from July 2011 to May 2019 for retrospective analysis. Microbial monitoring system was used to cultivate pathogens, API yeast identification kit and chromogenic medium were used to identify pathogens, and Kirby-Bauer paper disk diffusion method was used to detect drug resistance of fungi to fluconazole, amphotericin B, itraconazole, ketoconazole, and voriconazole. The positive rate of blood fungal culture, mortality rate, distribution of local fungal proliferation sites, the diagnosis time distribution of fungal bloodstream infection, the distribution of fungal species, resistance to commonly-used antifungal drugs, and the use of antibiotics were assessed. The WHONET 5.6 software was applied to analyze the distribution and drug resistance of fungi. (1) Totally 4 839 blood samples were collected during the 9 years, and 122 strains of fungi were isolated, with positive rate of 2.52%. The mortality rate was 14.55% (8 patients) in 55 patients. Catheter fungal proliferation ranked the first among 30 cases of local fungal proliferation. (2) The diagnosis time of fungal bloodstream infection mainly distributed in ≤1 week of hospitalization [32.73% (18/55)]. (3) Among the 55 strains of fungi detected, the detection rate of ranked the first (21.82%, 12 strains), was the second (18.18%, 10 strains), and was tied with in the third place (14.55%, 8 strains). All the detected fungi were sensitive to amphotericin B, and the resistance rates to voriconazole, fluconazole, itraconazole, and ketoconazole were between 4.5% and 9.1%. (4) Droad-spectrum antibiotics were used in all the 55 patients, ≥3 kinds of antibiotics were used in 44 patients, and 37 patients used antibacterial drugs ≥7 days. The diagnosis time of fungal bloodstream infection in the 55 severe burn patients was mainly within 1 week of hospitalization. is the most commonly detected fungal species. Catheter fungal proliferation occurs most commonly among the 30 patients with local fungal proliferation. All the detected fungi were sensitive to amphotericin B, with low drug resistance to voriconazole, fluconazole, itraconazole, and ketoconazole. Broad-spectrum antibiotics were overused in the severe burn patients with fungal bloodstream infection.
回顾性分析重度烧伤患者真菌血流感染的诊断时间、病原菌分布及耐药情况。收集2011年7月至2019年5月陆军军医大学第一附属医院（第三军医大学）烧伤研究所重症监护病房收治的55例重度烧伤真菌血流感染患者（男46例，女9例，年龄42（1，78）岁）的血样进行回顾性分析。采用微生物监测系统培养病原菌，用API酵母菌鉴定试剂盒和显色培养基鉴定病原菌，采用 Kirby-Bauer纸片扩散法检测真菌对氟康唑、两性霉素B、伊曲康唑、酮康唑和伏立康唑的耐药性。评估血真菌培养阳性率、死亡率、局部真菌增殖部位分布、真菌血流感染的诊断时间分布、真菌种类分布、对常用抗真菌药物的耐药性及抗生素使用情况。应用WHONET 5.6软件分析真菌的分布及耐药情况。（1）9年间共采集血样4 839份，分离出真菌122株，阳性率为2.52%。55例患者中死亡率为14.55%（8例）。30例局部真菌增殖中导管真菌增殖居首位。（2）真菌血流感染的诊断时间主要分布在住院≤1周[32.73%（18/55）]。（3）在检测的55株真菌中，检测率居首位（21.82%，12株），次之（18.18%，10株），与并列第三（14.55%，8株）。所有检测到的真菌对两性霉素B敏感，对伏立康唑、氟康唑、伊曲康唑和酮康唑的耐药率在4.5%至9.1%之间。（4）55例患者均使用了广谱抗生素，44例患者使用≥3种抗生素，37例患者使用抗菌药物≥7天。55例重度烧伤患者真菌血流感染的诊断时间主要在住院1周内。是最常检测到的真菌种类。30例局部真菌增殖患者中导管真菌增殖最常见。所有检测到的真菌对两性霉素B敏感，对伏立康唑、氟康唑、伊曲康唑和酮康唑耐药性低。重度烧伤真菌血流感染患者存在广谱抗生素滥用情况。
