老年慢性阻塞性肺疾病机械通气患者肺部真菌感染的分析

Pulmonary Fungal Infection and Resistance in Older Chronic Obstructive Pulmonary Disease Patients with Mechanical Ventilation

目的探讨老年老年慢性阻塞性肺疾病(COPD)机械通气患者肺部真菌感染的病原学及治疗。方法回顾性分析医院ICU在2004年1月-2007年12月收治128例行机械通气治疗的老年COPD患者,取肺泡灌洗液行真菌培养、鉴定及药敏测定。结果有78例患者肺泡灌洗液中共分离出真菌78株,其中白色假丝酵母菌41株(52.56%),热带假丝酵母菌14株(17.95%),克柔假丝酵母菌9株(11.54%),近平滑假丝酵母菌5株(6.41%),酵母样真菌7株(8.98%),曲霉菌属2株(2.56%),对两性霉素B的敏感率>80.00%,氟康唑、伏立康唑、伊曲康唑的敏感性>70.00%。结论老年COPD机械通气患者肺部真菌感染率在上升,其中仍以白色假丝酵母菌为主,对三氮唑类药物的耐药性也在增加。

OBJECTIVE To investigate pulmonary fungal infection spectrum and its resistance in older COPD patients with mechanical ventilation. METHODS Retrospective study were performed in 67 cases of COPD patients with mechanical ventilation treatment who were admitted to our ICU from Jan 2004 to Doc 2007. Bronchoalveolar lavage fluid was cultured, differentiation and antifungal susceptilibity testing were taken. RESULTS Seventy-eight fungi strains were cultured in 78 cases, among them, 41 strains were Candida albicans（52.56%）, 14 of C. tropicalis, 9 of C. krusei, 5 of C. parapsilosis,7 of yeast-like fungi and 2 of Aspergillus. CONCLUSIONS There were increasing fungal infection rate in older COPD patients with mechanical ventilation and C. albicans is still the most frequent type. The resistance to triazole antifungal drug is also increasing.