呼吸内科病房院内肺部真菌感染的临床分析

Clinical Analysis on Nosocomial Pulmonary Fungal Infection in Respiratory Department Ward

目的分析我院呼吸内科病房院内肺部真菌感染菌株类型、分布、危险因素、基础病及治疗转归等,为以后临床提供参考。方法采集广东新兴县人民医院2010年5月至2013年5月呼吸科病房收治并确诊为肺部真菌感染的295例患者临床资料,进行分析总结。结果分离出的前三位菌株主要为念珠菌属、曲霉菌属、卡式肺孢子菌等,分别占比例为58.3%,21.7%,5.1%。白色假丝酵母菌占念珠菌属的59.3%。前三位菌属药物敏感性,念珠菌属与曲霉菌属的敏感性依次为伏立康唑、两性霉素B、5-氟胞嘧啶、氟康唑及伊曲康唑,卡式肺孢子菌对所有抗真菌药不敏感。肺部基础病前三位为慢性阻塞性肺病、肺癌及肺转移癌、支气管扩张,三者占总比例的77.6%。院内肺部真菌感染危险因素包括性别、高龄(≥60岁)、抗生素联用(≥2种)、抗生素疗程≥2周、住院时间(≥4周)、应用免疫抑制剂、行气管插管及切开、机械通气及创伤性诊疗操作等。结论呼吸内科病房院内肺部真菌感染是多因素造成的,治疗过程中应尽量避免或减少相关危险因素,积极对肺部疾病进行治疗,提高真菌染的治愈率。

Objective To analyze strain types of fungus, distribution, risk factors, basis lung disease and treatment outcome of nosoeomial pulmonary fungal infection in respiratory department ward, in order to provide reference for the diagnosis and treatment in future. Methods Clinical data of 295 cases with nosocomial pulmonary fungal infection admitted in respiratory department ward of Xinxing County People′s Hospital from May 2010 to May 2013 were retrospectively analyzed. Results The top three strains isolated from all the cases were candida, aspergillus, pneumocystis carinii, respectively accounted for 58.3%, 21.7 %, 5.1%. Candida albicans accounted for 59.3% of candidas. The top three strains had drug sensitivity, candida, aspergillus had the drug sensitivity of voriconasole, amphotericin B,5-fluorocytosine,fluconazole and itraconazole successively ,pneumocysti s carinii is not sensitive to all antifungal drugs. Chronic obstructive pulmonary disease ,lung cancer and metastatic lung cancer, bronchiectasis are the top three basis lung diseases, accounting for 77.6% of the total. The risk factors of nosocomial pulmonary fungal infection included gender, advanced age（≥60 years）, antibiotics use （≥2 kinds ）, course of antibiotics （≥2 weeks ）, hospitalization time（≥4 weeks）, use of immunosuppressant, endotracheal intubation and tracheotomy, mechanical ventilation and traumatic treatment operation, etc. Conclusion Nosocomial pulmonary fungal infection is caused by multiple factors in respiratory department ward. It is important to avoid or reduce the risk factors in the treatment process and actively treat basis lung disease to improve the cure rate of fungal infection.