老年慢性阻塞性肺疾病急性发作时真菌感染种类及耐药性

Species of fungi causing infections in elderly patients with acute exacerbation of chronic obstructive pulmonary disease and analysis of drug resistance

目的讨论老年慢性阻塞性肺疾病急性发作(AECOPD)患者合并真菌感染的真菌种类及耐药性,并对其分布趋势及耐药特点进行研究,为临床合理使用抗真菌药物、减少真菌感染及耐药发生提供依据。方法以确诊为AECOPD的老年患者为调查对象,能自行咳嗽者经3%H2O2溶液漱口后深咳出深部痰液,不能自行咳痰者用无菌痰液收集器吸取下呼吸道分泌物作为痰标本,萨布罗培养基进行培养并行药敏试验;操作及结果判断参考NCCLS标准。结果 221例长期反复使用广谱抗菌药物且有不同程度使用糖皮激素老年患者有118例痰培养出真菌118株,以假丝酵母菌属为主占83.1%;其中又以白色假丝酵母菌比例最高占42.4%;分离菌株对抗真菌药物的敏感性分别为两性霉素B 94.07%、氟胞嘧啶93.22%、伊曲康唑72.03%、咪康唑70.34%、氟康唑33.51%、酮康唑28.81%。结论院内真菌感染AECOPD合并真菌感染比率呈上升趋势,且以假丝酵母菌属多见,作为条件致病菌的真菌感染已成为重要的医院感染的致病菌之一,特别是老年AECOPD患者肺部合并各类真菌感染在医院感染中的比例呈上升趋势,并有相当一部份成为致死性终末感染。

OBJECTIVE To discuss the species and drug resistance of the fungi causing fungal infections in the elderly patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） and explore the distribution and the characteristics of drug resistance so as to provide basis for the reasonable use of antibiotics and the reduction of fungal infections as well as the drug resistance. METHODS The elderly patients who were diagnosed as AECOPD in the department of respiratory medicine were enrolled in the study, cultivate deep sputum coughed by patients who can could by themselves through rinsing their mouth with 30//oo H202 solution or respiratory secretions absorbed from patients who could cough by themselves with sterile sputum collector as sputum sample Sabouraud culture medium to carry out drug sensitive test. The operation result was judged by referring to the NCCLS standards. RESULTS Among 221 cases, the senior patients used broad spectrum antibiotics repeatedly and couverture hormone to a certain degree, and there were 118 sputum cultivation results showing other bacteria combination of fungus infections, giving priority to Candida albicans which occupied 83.1 % ; the ratio of C. albicans was the highest （42.4 %）. The drug susceptibility rates of the isolated strains to amphotericin B was 94.07 %, 5-fluorocytosine 93.22 %, itraconazole 72.03 %, miconazole 70.34 %, fluconazole 33.51 %, and ketoconazole 28.81%. CONCLUSION The proportion of the cases complicated with fungal infections in the AECOPD patients is increasing, and the Candida are dominant among the opportunistic pathogens causing the fungal infections which take an increasing proportion among the nosocomial infections, a fairly large number of patients have become fatal infections.