COPD患者继发肺部真菌感染57例临床分析

Clinical Analysis of mycotic infection in 57 Cases with chronic obstructive pulmonary disease

目的了解我院COPD患者继发肺部真菌感染的临床特点、菌种分布及耐药现状。方法选择我院2003年3月～2007年3月住院诊断为COPD患者的痰液标本,连续3次培养,使用CAN-DIFAST真菌二合一鉴定系统做鉴定及药敏。结果57例痰真菌阳性COPD急性加重期患者,检测出白色念珠菌35例(61.4%),光滑念珠菌7例(12.3%),热带念珠菌(8.8%),克柔念珠菌3例(5.3%),酵母样真菌6例(10.5%),毛霉菌1例(1.8%)。药敏分析:真菌对多种抗真菌药物敏感率较高,其中二性霉素B对所有真菌耐药率仅为0.2%,氟胞嘧啶和伊曲康唑的总耐药率分别为19.3%及12.3%,而氟康唑的耐药率最高,为26.3%。结论COPD患者继发肺部真菌感染且有逐年增加趋势应引起重视。其中以白色念珠菌为主,其它真菌亦有上升趋势。两性霉素B、伊曲康唑、氟胞嘧啶等抗真菌药物有很好的疗效。

Objective To discuss the clinical characteristics, cultures as well as drug resistance of mycotic infection in patients with chronic obstructive pulmonary disease（COPD）. Methods The data of 57 cases of COPD were analyzed who were admitted between March 2003 and March 2007 in Department of Pulmonary Medicine of the 1st Affiliated Hospital of Anhui Medical University. The sputamentum specimens were identified and taken for drug sensitive test by CAN-DIFAST system. Results The 57 cases of COPD with mycotic infection included 35 cases of candida albicans, 7 cases of candida glabrata, 5 cases of candida tropicalis, 3 cases of candida krusei, 6 cases of yeast-like fungi and 1 case of mucormycosis. The drug sensitive analysis： Resistance rate of amphotericin b was 0. 2% meanwhile resistance rates of fluorocytosine and itraconazole were respectively 19.3 % and 12.3 % , and resistance rate of fluconazole was highest, about 26.3 %. Conclusion The rates of mycotic infection in patients with COPD have increased yearly which requires attentions. The infections of candida albicans take the lead, and other fungi also show an upward trend. Amphotericln b, fluorocytosine and itraeonazol had good treatment effect.