老年肺结核并存糖尿病合并下呼吸道真菌感染的临床分析

Clinical analysis of aged pulmonary tuberculosis and diabetes complicated with fungal infection of lower respiratory tract

目的探讨老年肺结核并存糖尿病患者合并下呼吸道真菌感染的病原学特征和耐药情况,为今后真菌感染的预防和治疗提供病原学依据。方法对浙江大学西溪校区校医院2009年1月至2013年12月共计127例老年肺结核并存糖尿病患者合并下呼吸道真菌感染的病例进行回顾性分析,研究其病原菌分布及耐药特征;采用ATB自动细菌鉴定仪及配套鉴定药敏条进行试验,按CLSI标准判定药敏结果,用WHONET 5.6软件分析数据。结果 127株真菌主要为白假丝酵母菌,占59.8%,其次为热带假丝酵母菌,占13.4%,药敏结果显示5种主要酵母样真菌对伊曲康唑的耐药率最高,对5-氟胞嘧啶和两性霉素B全敏感。结论从老年肺结核并存糖尿病患者下呼吸道中分离出的真菌对常用抗真菌药物已具有一定的耐药性,临床应加强监测与控制,并根据药敏试验结果合理用药。

Objective To study the etiological features and drug resistance in aged patients with pulmonary tuberculosis and diabetes complicated with fungal infection of low respiratory tract,and provide etiological basis for future prevention and treatment of fungal infections. Methods In our hospital from January 2009 to December2013,a total of 127 cases of senile pulmonary tuberculosis and diabetes complicated with fungal infection of lower respiratory tract were retrospectively analyzed; the pathogen distribution and drug-resistance were studied; ATB automatic bacterial identification system and sensitivity testing strip were used and the results were confirmed according to CLSI standard; WHONET 5. 6 software was used to analyze the data. Results The main pathogen was Candida albicans,accounting for 59. 8 %,followed by Tropical candida,accounting for 13. 4%. The 5 yeast-like fungi showed the highest resistance rates to itraconazole,while sensitive to 5-fluorine cytosine and amphotericin B.Conclusion The fungi isolated from elderly patients with pulmonary tuberculosis and diabetes complicated with fungal infection of lower respiratory tract have developed certain resistance to commonly used antifungal agents. The monitoring and control of the pathogens should be strengthened,and drugs should be used rationally based on drug susceptibility test results.