目的 分析阿萨希毛孢子菌泌尿系感染的流行病学、感染状况、危险因素以及微生物学的特征,指导临床选择及时、有效的抗真菌治疗.方法 收集分离自2013至2016年泌尿系感染患者的18株阿萨希毛孢子菌,对该病原菌的分离鉴定、药敏试验以及病历资料进行流行病学回顾性调查.结果 18株阿萨希毛孢子菌对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑、伏立康唑的耐药率分别为0、5.6％、0、0、0,但是伊曲康唑的敏感率仅为50.0％.阿萨希毛孢子菌泌尿系统感染的风险因素以男性、患有基础疾病(占100％)、长期使用广谱抗菌药物(占100％)、留导尿管(占83.3％)、皮质激素的应用(占50.0％)、免疫抑制剂应用(占38.9％)为主,粒细胞减少的比例较少(占5.6％).临床16例选用氟康唑治疗好转,另2例用伊曲康唑、伏立康唑治疗后死亡,其主要死亡原因与真菌治疗无关.结论 阿萨希毛孢子菌可引起泌尿系统感染,高危因素主要有基础疾病、广谱抗菌药物的长期使用和留置导尿管等,治疗首选氟康唑.及早明确病原学诊断、正确选用抗真菌药物是成功治疗阿萨希毛孢子菌感染的关键.%Objective To analyze the epidemiology,infection status,risk factors and microbiological characteristics of Trichosporon asahii in urinary tract infection for guidance of selecting the prompt and effective antifungal drugs in clinical therapy.Methods A total of 18 strains of Trichosporon asahii isolated from the patients with urinary tract infection were selected from 2013 to 2016.The isolation and identification of pathogenic bacteria,results of antimicrobial susceptibility test and clinical data were investigated by retrospective epidemiological survey.Results The 5 antifungal drugs,i.e.,5-fluorocytosine,amphotericin B,fluconazole,itraconazole and voriconazole,exhibited favorable antibacterial activity for the 18 strains of Trichosporon asahii with resistance rate of 0,5.6％,0,0 and 0 except itraconazole which showed only 50％ of sensitive rate.The risk factors of Trichosporon asahii infection in urinary system mainly included such as male,basic diseases (100％),long-term use of broad-spectrum antimicrobial agents (100％),indwelling catheter (83.3 ％),application of corticosteroids (50.0％) and immunosuppressive agents (38.9％) as well as a small proportion of granulocytopenia (5.6％).The 16 cases treated with fluconazole were improved,while the other 2 cases died following the treatment with itraconazole or voriconazole for reasons irrelevant to antifungal treatment.Conclusion Trichosporon asahii could cause urinary tract infections with high risk factors including basic diseases,long-term use of broad-spectrum antimicrobial agents,indwelling catheter,etc.The drug of top choice should be fluconazole.The key elements for successful treatment of Trichosporon asahii infection include early diagnosis of pathogens and correct selection of antifungal agents based on sensitivity and resistance tests of drugs.
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