老年慢性支气管炎合并真菌感染患者的临床治疗

Clinical treatment of elderly chronic bronchitis patients complicated with fungal infections

目的探讨老年慢性支气管炎合并真菌感染患者临床资料、病原菌分布及诱发真菌感染的相关因素,为临床诊断治疗提供可靠依据。方法选取2011年12月-2015年9月医院收治的慢性支气管炎老年患者769例为研究对象,收集相关的临床资料,对感染患者的送检标本进行真菌培养和药敏试验,统计患者真菌感染率、感染部位、病原菌分布,分析真菌感染的相关因素及抗真菌治疗效果;采用SPSS19.0软件进行统计分析。结果 769例老年慢性支气管炎中合并真菌感染34例,感染率为4.42%;感染部位以肺部最常见,占52.94%,其次为泌尿道和肠道,分别占20.59%和14.71%;共分离出真菌49株,其中白色假丝酵母菌30株占61.23%,热带假丝酵母菌7株占14.29%,两者共占总菌数的75.52%;年龄、吸烟史、糖尿病史、侵入性操作、抗菌药物的使用时间及种类是慢性支气管炎合并真菌感染的影响因素;经治疗后,痊愈13例占8.24%,显效10例占29.41%,进步7例占20.59%,无效4例占11.76%;总有效率为67.75%。结论老年慢性支气管炎合并真菌感染以肺部组织最常见,致病真菌以白色假丝酵母菌为主,治疗中应重视年龄、吸烟史、糖尿病史、侵入性操作、抗菌药物的使用时间及种类等相关影响因素,采取积极治疗措施,提高治愈率。

OBJECTIVE To explore the clinical data of the elderly chronic bronchitis patients complicated with fungal infections,investigate the distribution of pathogens,and analyze the related factors for the induced fungal infections so as to provide reliable basis for clinical treatment.METHODS A total of 769 elderly patients with chronic bronchitis who were treated in hospitals from Dec 2011 to Sep 2015 were enrolled in the study,the relevant clinical data were collected,the fungal culture was conducted for submitted specimens of the patients with infections,and the drug susceptibility testing was carried out.The incidence of fungal infections,infection sites,and distribution of pathogens were statistically analyzed,the related factors for fungal infections and antifungal treatment effect were observed,and the statistical analysis was performed with the use of SPSS19.0software.RESULTS The fungal infections occurred in 34 of 769elderly patients with chronic bronchitis,with the infection rate 4.42%;the patients with pulmonary infections accounted for 52.94%,the patients with urinary tract infections accounted for20.59%,and the patients with intestinal tract infections accounted for 14.71%.Totally 49 strains of fungi were isolated,of which 61.23%（30strains）were Candida albicans,and 14.29%（7strains）were Candida tropicalis;the two species accounted for 75.52%.The influencing factors for the fungal infections in the patients with chronic bronchitis included the age,smoking history,diabetic mellitus,invasive operations,time of use of antibiotics,and types of used antibiotics.Totally 13（8.24%）patients were cured after the treatment,10（29.41%）patients were effective,7（20.59%）patients were improved,and 4（11.76%）patients were ineffective,with the total effective rate 67.75%.CONCLUSIONThe pulmonary infection is the most common among the elderly chronic bronchitis patents complicated with fungal infections,and the C.albicansis the predominant species of pathogenic fungus.It is necessary to pay attention to the related influencing factors during the treatment,including the age,smoking history,diabetic mellitus history,invasive operations,time of use of antibiotics,and types of used antibiotics,and take active treatment measures so as to raise the cure rate.