老年慢性阻塞性肺疾病患者继发真菌感染的研究分析

Study on secondary fungal infections in elderly patients with chronic obstructive pulmonary disease

目的研究老年慢性阻塞性肺疾病(COPD)患者继发真菌感染的临床资料及病原菌分布,并探讨相关易感因素,为临床治疗提供可行依据。方法选取2009年1月-2013年6月医院收治的老年COPD患者1 598例为研究对象,其中67例患者继发真菌感染,采集感染患者相关标本进行真菌培养及药敏试验,对病原菌和易感因素进行统计分析。结果医院共收治1 598例老年COPD患者,其中67例继发真菌感染,感染率为4.19%;共分离出病原菌84株,其中白色假丝酵母菌、克柔假丝酵母菌、热带假丝酵母菌、隐球酵母菌属、曲霉菌属、烟曲霉菌分别占63.10%、13.10%、10.71%、5.95%、4.76%、2.38%;单因素分析显示,住院时间、侵入性操作、抗菌药物种类、抗菌药物使用时间、激素使用时间和糖尿病史是真菌感染的相关影响因素(P<0.05)。结论老年COPD患者真菌感染以肺部感染为主,检出病原菌以白色假丝酵母菌为主,在临床治疗过程中应注意真菌感染相关影响因素,采取有效预防措施,减少感染的发生。

OBJECTIVE To study the clinical data of the elderly patients with chronic obstructive pulmonary disease （COPD） complicated with secondary fungal infections ,observe the distribution of pathogens ,and explore the re‐lated predisposing factors so as to provide reliable basis for clinical treatment .METHODS A total of 1 598 elderly patients with COPD who were treated in the hospital from Jan 2009 to Jun 2013 were recruited as the study ob‐jects ,including 67 cases of secondary fungal infections .The related specimens were collected from the patients with infections so as to conduct the culture of fungi and the drug susceptibility testing ,and the distribution of pathogens and the predisposing factors were statistically analyzed .RESULTS The secondary fungal infections oc‐curred in 67 of 1 598 elderly patients with COPD ,with the infection rate of 4 .19% .Among the 84 strains of pathogens isolated ,the Candida albicans accounted for 63 .10% ,Candida krusei 13 .10% ,Candida tropicalis 10.71% ,Cryptococcusspp5.95% ,Aspergillus4.76% ,Aspergillusfumigatus2.38% .Theunivariateanalysis indicated that the length of hospital stay ,invasive operation ,types of antibiotics ,time of use of antibiotics ,time of use of hormones ,and history of diabetic mellitus were the related influencing factors for the fungal infections （P〈0 .05） .CONCLUSION The pulmonary infections dominate the fungal infections in the elderly patients with COPD .The C .albicans is the predominant species of isolated pathogen .It is necessary to pay attention to the relat‐ed influencing factors for the fungal infections during the clinical treatment and take effective prevention measures so as to reduce the incidence of infections .