慢性阻塞性肺疾病急性加重期住院患者肺部真菌感染临床分析

Clinical analysis of pulmonay fungal infections in hospitalized patients in acute exacerbation period of chronic obstructive pulmonary diseases

目的探讨与分析慢性阻塞性肺疾病(COPD)急性加重期(AECOPD)住院患者肺部真菌感染及耐药性,为治疗提供有效数据。方法选择52例住院治疗的肺部真菌感染AECOPD患者作为感染组,选择同期的肺部非真菌感染AECOPD患者30例作为对照组;收集感染组患者痰液标本进行真菌鉴定与药物敏感试验;初步分析AECOPD肺部真菌感染的危险因素。结果感染组患者共检出真菌64株,白色假丝酵母菌、热带假丝酵母菌、克柔假丝酵母菌、光滑假丝酵母菌、近平滑假丝酵母菌、毛霉菌属、青霉菌属、烟曲霉菌分别占60.94%、12.50%、6.25%、4.49%、6.25%、3.12%、4.49%、1.56%;白色假丝酵母菌对制菌霉素、两性霉素B、伊曲康唑较敏感,对酮康唑及5-氟胞嘧啶的敏感性较差;感染组患者广谱抗菌药物使用、住院、机械通气、糖皮质激素使用时间显著长于对照组;血清白蛋白水平显著低于对照组,差异均有统计学意义(P<0.05)。结论 AECOPD患者肺部真菌感染主要以白色假丝酵母菌为主,临床治疗时应选择具有针对性的窄谱抗菌药物,此外,还要在早期对可能的危险因素进行干预。

OBJECTIVE To explore the pulmonary fungal infections in the hospitalized patients in the acute exacerbation period of chronic obstructive pulmonary disease（COPD） and analyzed the drug resistance so as to provide effective dato for clini cal treatment.METHODS A total of 52 patients with AECOPD and pulmonary fungus infection were set as the infection group,30 AECOPD patients with non-fungal infections were set as the control group.The sputum specimens of the infection group were collected to detect fungal species and perform the drug susceptibility testing.The preliminary analysis of the risk factors for pulmonary fungal infections in AECOPD patients was performed.RESULTS Totally 64 strains of fungi were isolated from the infection group,including Candida albicans（60.94%）,C.tropicalis（12.50%）,C.krusei（6.25%）,Smooth candida（4.69%）,C.parapsilosi（6.25%）,Mucor（3.12%）,Penicillium（4.69%）,Aspergillus fumigutus（1.56%）;C.albicans was highly susceptible to nystatin,amphotericin B,and itraconazole and highly resistant to ketoconazole and 5-fluorocytosine.The duration of use of broad spectrum antibiotics,hospitalization,mechanical ventilation,and use of glucocorticoid was significantly longer than that of the control group,and the serum albumin level of the infection group was significantly lower than that of the control group,the difference was statistically signifl cant（P0.05）.CONCLUSION C.albicans is the predominant species of fungi causing pulmonary infections in the AECOPD patients.The narrow-spectrum antibiotics should be taken correspondingly for the clinical treatment,in addition,the interventions should be conducted to the potential risk factors in the early stage.