肿瘤放化疗患者真菌感染临床探析

Clinical Analysis of Fungal Infection of Tumor Patients Treated by Radiotherapy and Chemotherapy

目的探讨肿瘤放化疗患者真菌感染的菌种分布情况和真菌感染的相关危险因素以及真菌的耐药性,为控制肿瘤放化疗患者的真菌感染提供科学理论依据,有针对性、高效性的预防和控制感染发生。方法选择该院自2010年1月—2012年12月以来住院进行放化疗的患有恶性肿瘤的病人130例。取病患的痰液、胸腹水、尿液、粪便及血液等作为实验标本进行真菌培养,经分离后,进行药敏试验分析。结果 130例患者的373份标本真菌培养后得56株真菌,阳性率为15.018%;经分离后鉴定,感染的真菌种类包括有白色假丝酵母菌、热带假丝酵母菌、光滑假丝酵母菌、克柔假丝酵母菌、其他假丝酵母菌,其中以白色假丝酵母菌(40株)为分布最多,占总菌数的71.43%,其次为热带假丝酵母菌(8株),占14.29%;真菌感染的相关因素为癌症患者的放化疗、抗菌药物的不合理应用以及不当的激素治疗和侵入性操作等;真菌对酮康唑、益康唑类抗菌药物有较强的耐药性,其耐药率分别为25%、28.57%。结论科学合理的使用抗菌药物,明确其致病真菌种类有针对性的应用抗菌药,对于肿瘤放化疗患者真菌感染的控制有重要意义,同时减少了耐药菌株的产生,预防继发性感染。

Objective To investigate the distribution of strains and related risk factors of fungal infection and drug resistance of fungi so as to provide a scientific basis for the control of fungal infection of tumor patients treated by radiotherapy and chemotherapy, prevent and control fungal infection targetedly and efficiently. Methods 130 patients with malignant tumor underwent radiotherapy and chemotherapy in our hospital from January, 2010 to December, 2012 were selected. The sputum, pleural and ascitic fluid, urine, feces and blood of the patients were taken as the experimental samples and cultured for fungi. After the isolation, the drug sensitivity test was analyzed. Results 56 strains of fungi were cultured from 373 samples of 130 patients, the positive rate was 15.018%. After the isolation, it was identified that the infection fungal species included Candida albicans, Candida tropicalis, Candida glabrata, Candida krusei and other Candida. Of which, Candida albicans（dO strains） had the largest distribution, accounting for 71.43% of the total number of bacteria, followed by Candida tropicalis（8 strains）, accounting for 14.29%. The related factors of fungal infection were the radiotherapy and chemotherapy for cancer patients, irrational use of antibacterial drugs, improper treatment of hormone and invasive operation. The fungi had strong resistance to ketoconazole and econazole antibiotics, the drug resistance rate was 25% and 28.57%, respectively. Conclusion Scientific and rational use of antimicrobial drugs, identifying the pathogenic fungi species and targeted use of antibiotics have important significance in controlling the fungal infection of tumor patients treated by radiotherapy and chemotherapy and can reduce the emergence of drug resistant strains and prevent the secondary infection.