目的 了解2014—2017年解放軍總醫(yī)院海南分院真菌的分布和耐藥特點，為促進(jìn)抗真菌藥的合理應(yīng)用、有效減緩真菌耐藥提供參考。方法 提取解放軍總醫(yī)院海南分院2014年1月—2017年12月臨床真菌分離和藥敏相關(guān)數(shù)據(jù)，分析真菌的分布特征及其對常用抗真菌藥的耐藥率和變化趨勢。結(jié)果 共納入1 048份陽性真菌樣本，呼吸道標(biāo)本占41.89%，60歲以上患者（61.45%）和重癥醫(yī)學(xué)科（25.48%）分布比例最高；共分離出1 329株真菌，白色念珠菌、念珠菌屬、熱帶念珠菌分別占24.53%、15.80%、13.69%。各種念珠菌對兩性霉素B和5-氟胞嘧啶的敏感率基本保持在90%以上；熱帶念珠菌對伊曲康唑耐藥率最高，達(dá)10%～20%，對氟康唑和伏立康唑的耐藥率亦高于兩性霉素B和5-氟胞嘧啶；白色念珠菌對伊曲康唑和伏立康唑的耐藥率呈逐年快速上升趨勢。結(jié)論 白色念珠菌和熱帶念珠菌感染應(yīng)慎用唑類抗真菌藥；兩性霉素B和5-氟胞嘧啶是念珠菌感染的有效選擇。

Objective To investigate the distribution and drug resistance of fungal in Hainan branch of PLA General Hospital from 2014 to 2017, and to provide reference for promoting the rational use of antifungal drugs and effectively alleviating fungal resistance. Methods According to the data on clinical isolates and drug susceptibility from January 2014 to December 2017 in Hainan branch of PLA General Hospital, the distribution characteristics and the resistance profile of fungi were analyzed, as well as the trend. Results Among the 1 048 samples of culture-positive fungal, most of them were isolated from respiratory tract (41.89%). Patients over 60 years old (61.45%) and patients in ICU (25.48%) took the higher proportion. Among the 1 329 strains of fungal, Candida albicans, Candida spp, and C. tropicalis accounted for 24.53%, 15.80%, and 13.69%, respectively. The sensitive rate of various candida to amphotericin B and 5-fluorouracil remained above 90%. The resistance rate of C. tropicalis against itraconazole was the highest, up to 10% - 20%. And the resistant rate of C. tropicalis against fluconazole and voriconazole were higher than those of amphotericin B and 5-fluorouracil. And the resistant rate of C. albicans against itraconazole and voriconazole was increased rapidly year by year. Conclusion The pyrroles antifungal agents should be used with caution for the infection of C. albicans and C. Tropicalis. Amphotericin B and 5-fluorouracil are effective candidates for Candida species infections.

國家自然科學(xué)基金資助項目（81573472、81770004）；解放軍總醫(yī)院海南分院臨床科研扶持基金項目（2018FC-WJFWZX-1-15）