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目的对我院合并真菌感染的病例进行临床回顾性分析,从而为临床有目的性地制定针对性防治措施提供客观依据。方法收集新乡医学院第一附属医院2012年10月至2013年10月确诊的急性白血病合并真菌感染病例,用ATB全自动细菌鉴定分析仪对分离培养阳性的真菌菌株进行鉴定,并进行药敏实验。结果 256例急性白血病患者中发生真菌感染97例,感染发生率为37.9%;其中男性51例,女性46例,平均(34.9±14.2)岁。急性淋巴细胞白血病(ALL)占46例(47.4%),急性髓系细胞白血病(AML)占51例(52.6%)。真菌菌株对6种抗真菌药物的药敏率从高至低分别是:两性霉素B(AMB)94.7%,制霉菌素(NYT)93.4%,5-氟胞嘧啶(5-FC)88.4%,咪康唑(MIC)75.4%,酮康唑(KTC)63.5%,益康唑(ECO)59.2%。结论两性霉素、制霉菌素以及5-氟胞嘧啶保持着很高的抗菌活性,仍是临床上值得信赖的抗真菌首选药物。咪康唑、酮康唑、益康唑等唑类抗真菌药物的耐药性日益增多。
Objective To retrospectively analyze the clinical cases of fungal infection in our hospital so as to provide an objective basis for the targeted prevention and treatment measures. Methods The cases of acute leukemia complicated with fungal infection diagnosed in the First Affiliated Hospital of Xinxiang Medical College from October 2012 to October 2013 were collected, and the positive fungal strains isolated and identified were identified by ATB automatic bacterial identification analyzer, and drug sensitivity test . Results A total of 97 cases of fungal infections were found in 256 patients with acute leukemia and the infection rate was 37.9%. There were 51 males and 46 females with an average of 34.9 ± 14.2 years. Acute lymphoblastic leukemia (ALL) accounted for 46 cases (47.4%), acute myeloid leukemia (AML) accounted for 51 cases (52.6%). The highest and lowest susceptibilities of the fungal strains to the six antifungal agents were 94.7% for amphotericin B (AMB), 93.4% for nystatin (NYT), 88.4% for 5-fluorocytosine (5-FC) , Miconazole (MIC) 75.4%, ketoconazole (KTC) 63.5% and econazole (ECO) 59.2%. Conclusion Amphotericin, nystatin and 5-fluorocytosine have a high antibacterial activity and are still the drug of choice for antifungal therapy in clinical practice. Antibiotics such as miconazole, ketoconazole, and econazole have become increasingly resistant.