老年患者医院内下呼吸道真菌感染相关因素分析

Analysis of correlative factor for nosocomial fungal infection of lower respiratory tract in old patients

目的分析老年患者医院内呼吸道真菌感染主要相关因素及菌种分布,为其早期诊断和有效治疗提供依据。方法对医院呼吸科2002年1月￣2004年11月60岁以上的住院患者发生呼吸道真菌感染57例进行回顾性分析。结果发生医院内呼吸道真菌感染的67例患者中>60岁的患者占85.1%,所有病例均伴有明显的基础疾病,3种以上疾病并存的患者56例,占98.25%。全部患者在真菌感染前均反复使用过多种抗生素,39例患者使用过糖皮质激素,占68.42%。5例患者接受化疗或放疗,占8.77%。20例患者接受过侵入性操作,占35.09%。57例患者中40例检出白色念珠菌(70.18%),8例热带念珠菌(14.04%),6例其它念珠菌(10.53%),2例平滑念珠菌(3.5%),1例克柔念珠菌(1.75%)。结论老年患者医院内呼吸道真菌感染与年龄、基础疾病、抗生素和糖皮质激素及免疫抑制剂的应用、留置导管等有关。白色念珠菌仍是医院内真菌感染的主要病原,占70.18%。临床上应警惕真菌感染,及早诊断和有效治疗,从而降低该病的病死率。

[Objective] Analyze major correlation factor and distribution of fungous strains in nosocomial fungal infection of lower respiratory tract in old patients. [Methods] The age of 57 cases of nosocomial fungal infection of lower respiratory tract were ≥60 years old and hospitalized in our respiratory department hospital from January 2002 to November 2004, clinical data had been collected and analyzed. [Results] ≥60 years old among 67 cases of nosocomial fungal infection of lower respiratory tract are 57 cases （85.1%）, all patients had one or many kinds of diseases, 56 cases （98.25%） had 3 or more than 3 kinds of diseases COncomitantly. 57 cases received repeatedly broad-spectrum antimicrobial agents and 39 cases （68.42%） received glucocorticosteroid, 5 cases （8.77%） received chems or radiotherapy, 20 cases （35.09%） received indwelling catheter before nosocomial fungal infection. The main pathogens were Candida albicans （70.18%）, Candida tropicalis （14.04%）, Candida glabrata （3.5%）, Candida krusei （1.75%）, other Candida（10.53%）. [Conclusions] Developments of nosocomial fungal infection in old patients were closely associated with old age, ground diseases, infusion of broad-spectrum antimicrobial agents, immunosuppressire therapy, indwelling catheter. Candida albicans are still the main pathogens nosocomial fungal infection, fungal infection should be detected closely in clinically. If the diagnosis is made early and the treatment is admitted effectively, the fatality will depress.