老年临终患者并发深部真菌感染98例临床分析

Clinical analysis of elderly hospice inpatients concurrent with deep fungal infection

目的探讨老年临终患者并发深部真菌感染的感染部位、病原学及危险因素,以利于合理防治。方法回顾性分析2009年6月至2011年12月期间收治的98例并发深部真菌感染老年临终患者的临床资料,分析感染部位、病原学、耐药性及危险因素。结果感染部位依次为:呼吸道(57.14%),消化道(18.37%),泌尿道(14.29%),手术部位(5.10%),生殖道(3.06%),血液(2.04%);病原菌显示:白色假丝酵母菌感染最多(46.94%),其次为光滑假丝酵母菌(24.49%)、热带假丝酵母菌等(17.35%);药敏提示:氟康唑耐药性较高,伊曲康唑次之、伏立康唑较低,5-氟胞嘧啶、两性霉素-B最低;易感因素有:年龄、应用广谱抗生素、使用糖皮质激素、侵入性操作、贫血及低蛋白血症、基础疾病等。结论加强老年临终患者深部真菌感染的监控,针对易感染部位、危险因素重视早期预防和治疗。

Objective To investigate the infection location,pathogenic characteristics and risk factors influencing the occurrence of fungal infection in elderly hospice inpatients,adopt reasonable protective and therapeutic measures.Methods The clinical materials of 98 elderly hospice inpatients infected with deep fungal from June 2009 to December 2011 were retrospectively analyzed about the infection location,Genus characteristics,drug resistance and risk factors.Results Respiratory system（57.14%）,digestive system（18.37%）,urinary tract（14.29%）,surgical site（5.10%）,reproductive tract（3.06%） and hematological system（2.04%） were the main infection location.The most common invasive fungal infection were Candida,Candida albicans（46.94%）,Candida glabrata（24.49%）,Candida tropicalis（17.35%）.The highest resistant rate were fluconazole and itraconazole,voriconazole,5-lucytosine and amphotericin B were the most sensitive drugs.The factors related to deep fungal infection were,long term use of broad-spectrum antibiotic and glucocorticoid,invasive monitoring and therapeutic tool,anemia and hypoproteinemia,underlying disease.Conclusion Clinicians should strengthen the surveillance to control deep fungal infection in elderly hospice inpatients.According to the infection location,pathogenic characteristics and risk factors,early diagnosis and treatment must be regarded.