36例老年医院获得性真菌性肺炎的临床分析

Clinical analysis of thirty-six elderly cases of hospital acquired mycotic pneumonia

目的对医院获得性真菌性肺炎老年患者的临床资料进行回顾性分析并探讨防治策略。方法对我院36例医院获得性真菌性肺炎老年患者的临床特征与资料进行分析。结果真菌培养共分离出36株,主要为白色念珠菌18株(50.0%);曲霉菌6株(16.7%),热带念珠菌5株(13.8%);光滑念珠菌4株(11.1%);丝状真菌3株(8.3%)。治愈23例,死亡13例。死亡率为36.1%。其中死于多脏器功能障碍综合征6例,感染性休克4例,原发疾病3例。结论老年人容易发生院内真菌性肺炎,及早作痰和纤维支气管镜灌洗液标本的真菌培养容易得到阳性结果,早期给予经验性和针对性抗真菌治疗可降低病死率。

Objective To analyze the hospital acquired mycotic pneumonia in the elderly patients retrospectively and to investigate the strategy of prevention and treatment. Methods The clinical data of thirty-six elderly patients with hospital acquired mycotic pneumonia in the Jintan Hospital Affiliated Jiangsu University from January 2005 to December 2012 were retrospectively analyzed. Results Thirty-six strains were cultivated,and among them,there were eighteen strains of candida albicans,six strains of aspergillus,five strains of oidium tropioale,four strains of glabrate candida and three strains of mycelial fungus. Twenty-three patients were cured and thirteen patients were dead,with a mortality rate of 36. 1%. Six patients died of multiple organ dysfunction syndrome,four of septic shock,three of primary diseases. Conclusions The elderly patients are easy to suffer from hospital acquired mycotic pneumonia. Cultivating sputum and bronchial lavage fluid as soon as possible may get positive results easily. Empirical and directed antifungal therapy at the early stage can reduce the case fatality rate.