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目的分析引起山东“10·21”辐射事故2例放射病人真菌感染的种类和药敏试验结果。方法用形态学方法结合VITEK(2全自动微生物分析仪以及API 20C AUX生化鉴定方法对临床标本进行微生物学鉴定,真菌药敏试验采用微量稀释法。结果在病例A的大便标本中培养出近平滑念珠菌,中段尿、血液、胸水、腹水、大便、骨髓血、两次咽拭子和脑脊液等标本中培养出申克孢子丝菌,痰液标本中培养出热带念珠菌。病例B的鼻腔、口腔、尿道口分泌物和腹腔引流液等标本中培养出阿萨丝孢酵母菌,痰标本中除阿萨丝孢酵母菌外,还培养出了土曲霉菌。随着抗真菌药物使用时间的延长,上述真菌对抗真菌药物的敏感性逐渐下降,最小抑菌浓度(MIC)逐渐增加。结论大多数抗真菌药物的体外药敏试验敏感,但患者的一般情况很差,常用剂量乃至较大剂量的用药只能抑菌而不能杀菌,且因临床预防性抗生素和抗真菌制剂的使用,常规的微生物培养方法很难培养出细菌或真菌。
Objective To analyze the species and susceptibility test results of 2 fungal infections caused by radiation accident in Shandong “10 · 21”. Methods The microbiological identification of clinical specimens was carried out by morphological method combined with VITEK (2 automatic microbiological analyzer and API 20C AUX biochemical identification method), and the micro-dilution method was used for the fungal susceptibility test.Results In the stool specimen of case A, Candida, the middle of urine, blood, pleural effusion, ascites, stool, bone marrow blood, two throat swabs and cerebrospinal fluid samples of spores in the culture Shencun, sputum specimens cultured in tropical Candida. Case B of the nasal cavity, Oral cavity, urethral orifice secretions and peritoneal drainage fluid culture specimens of Aspergillus aculeatus, sputum specimens in addition to Assassilis spore yeast, but also cultivate the Aspergillus terreus.With the anti-fungal drug use time , The sensitivity of the fungi to antifungal drugs gradually decreased and the minimum inhibitory concentration (MIC) gradually increased.Conclusion Most antifungal agents are susceptible to in vitro susceptibility testing, but the general condition of patients is very poor. The common and even higher doses Can only be bacteriostatic and not bactericidal, and because of the use of clinically preventative antibiotics and antifungal agents, it is very difficult for conventional microbial culture methods to produce bacteria or fungi