158例念珠菌肺炎病原学及抗菌药物治疗分析

Analysis of etiology and drug use in 158 cases of candida pneumonia

目的观察ICU念珠菌肺炎的病原菌分布情况和药物治疗情况。方法分析本院ICU158例念珠菌肺炎病例,对氟康唑敏感的用氟康唑治疗,耐药的用伏立康唑治疗。结果分离菌株162株,其中白色念珠菌129株(79.63%),热带念珠菌16株(9.88%),近平滑念珠菌11株(6.79%),克柔念珠菌6株(3.70%)。氟康唑耐药率高于伏立康唑,有统计学差异(t=2.83182,P=0.00316<0.05)。治疗1疗程后,真菌清除率52.83%,总有效率56.64%,2个疗程后,真菌清除率71.69%,总有效率76.92%。氟康唑组发现11例(10.19%)副反应较明显,伏立康唑组发现5例(10.0%)副反应较明显。结论念珠菌肺炎致病菌以白色念珠菌为主,部分菌株出现氟康唑耐药。抗真菌疗程宜在28天以上。用药过程中监测肝功能和其他不良反应。

Objective To observe condition of nosophyte and medicine about candida pneumonia. Methods To analyse 158 cases of candida pneumonia.Treat the drug faster to fluconazol with voriconazole while the others with fluconazol.Then analysed their monilia strain, drug sensitivity, drug use, effects, side effects. Results To separate 162 monilia strain.There were 129 plants albicans saccharomyces（79.63%）,16 plants candida tropicalis（9.88%）,11 plants candida parapsilosis（6.79%）,6 plants candida krusei（3.70%）. Drug resistance rate about fluconazol was higher than rate about voriconazole.There was statistical difference（t=2.83182,P=0.003160.05）.After one course treatment,clearance was 52.83%,total effective rate was 56.64%.After tow course treatment, clearance was52.83%,total effective rate was 76.92%.The fluconazol group had 11 cases（10.19%） side effect,the voriconazole group had 5 cases（10.0%） side effect. Conclusion The most monilia strain in candida pneumonia is albicans saccharomyces.Some monilia strain have drug fast to fluconazol.The course should be above 28 days.During the course liver function and other side effect should be watched.