慢性阻塞性肺疾病患者肺部真菌感染与耐药性研究

Pathogenic bacteria and drug resistance in patients with COPD complicated by pulmonary fungal infections

目的研究慢性阻塞性肺疾病(COPD)患者肺部真菌感染与耐药性,为临床治疗提供依据。方法选择2010年5月-2015年5月在医院就诊的COPD患者1 150例,采集痰液标本进行病原菌培养,采用中国珠海迪尔公司药敏分析系统检测最常见真菌对药物的耐药性。结果 1 150例COPD患者发生真菌感染120例,感染率为10.43%;共检出119株真菌,其中检出率最高的真菌为白色假丝酵母菌和曲霉菌属;真菌对抗菌药物的总耐药率由低到高依次为:伊曲康唑21.01%、氟胞嘧啶28.57%、两性霉素B 32.77%、制霉菌素33.61%,酮康唑较其他抗菌药物耐药率高,耐药率为50.42%;120例患者中61例好转、38例无效、21例死亡,其中10例死于基础疾病和多脏器功能衰竭,11例死于严重呼吸衰竭。结论 COPD并发肺部真菌感染患者应及时给予真菌检查,尽早发现致病菌,选择有效地抗菌药物进行治疗。

OBJECTIVE To study the pathogenic bacteria and drug resistance in patients with COPD complicated by pulmonary fungal infections.METHODS Totally 1 150 cases of COPD from May 2010 to May 2015 were selected.Sputum was collected for pathogen culture and the drug susceptibility analysis system from the Zhuhai DL Biotech Co.Ltd.was used for monitoring of drug resistance of the most common fungi.RESULTS A total of 120 cases of COPD patients had fungal infections,the positive rate was 10.43%.Totally 119 fungal strains were detected,of which the fungi with the highest detection rate were Candida albicans and Aspergillus.The resistance rate was21.01%to itraconazole,28.57%to 5-Fluorocytosine,32.77%to amphotericin B and 33.61%to nystatin.Ketoconazole had higher resistance rate than other antimicrobial drugs,being 50.42%.Of the 120 cases,61cases were improved,38 cases ineffective,21 cases died,of which 10 cases died of underlying diseases and multiple organ failure and 11 cases died of severe respiratory failure.CONCLUSIONPatients with COPD complicated with pulmonary fungal infection should be given timely mycological examination,early detection of pathogens and effective antimicrobial treatment.