老年肺结核患者肺部真菌感染分析

Pulmonary fungal infections in elderly patients with tuberculosis

目的研究老年肺结核合并肺部真菌感染及耐药性,为临床提供依据。方法选取2013年5月-2015年12月医院诊治的207例老年肺结核合并肺部真菌感染患者资料进行分析,采集入选患者标本,根据《全国临床检验操作规程》进行细菌培养、分离,根据美国临床实验室标准化委员会(NCCLS)标准进行药敏试验,分析老年肺结核合并肺部真菌感染病原菌分布及耐药性。结果 207例老年肺结核合并肺部真菌感染患者中痰液、纤支镜最高,分别占87.4%、8.7%;207例老年肺结核合并肺部真菌感染患者中真菌以白色念珠菌最高,占60.9%,其次为热带念珠菌及光滑念珠菌,分别占14.0%、8.2%;207株真菌对两性霉素B、5-氟胞嘧啶以及氟康唑的敏感率最高,分别为100.0%、97.1%以及93.7%,对酮康唑、益康唑以及伊曲康唑耐药率最高,分别为26.8%、23.7%以及7.9%。结论老年肺结核合并肺部真菌感染病原菌分布相对复杂,应加强药敏试验并根据结果选择敏感抗菌药物,提高临床治愈率。

OBJECTIVE To investigate the prevalence of pulmonary fungal infections in elderly patients with tuberculosis and analyze the drug resistance so as to provide guidance for clinical treatment.METHODS The clinical data were collected from 207 elderly tuberculosis patients complicated with pulmonary fungal infections who were treated in hospitals from May 2013 to Dec 2015,the specimens were obtained from the enrolled patients,the bacterial culture and isolation were carried out in accordance with′National Clinical Laboratory Procedures′,the drug susceptibility testing was performed on the basis of National Committee for Clinical Laboratory（NCCL）standards,and the distribution and drug resistance of the pathogens causing the pulmonary fungal infections in the elderly patients with tuberculosis were observed.RESULTS Among the specimens that were obtained from the 207 elderly tuberculosis patients complicated with pulmonary fungal infections,the sputum specimens accounted for 87.4%,and fiber bronchoscopes accounted for 8.7%.Of the fungi isolated from the 207 elderly tuberculosis patients complicated with pulmonary fungal infections,the Candida albicans accounted for 60.9%,the Candida tropicalis accounted for 14.0%,and the Candida glabrataaccounted for 8.2%.Among the 207 strains of fungi,the drug susceptibility rates to amphotericin B,5-fluorocytosine,and fluconazole were 100.0%,97.1%,and 93.7%,respectively;the drug resistance rates to ketoconazole,econazole,and itraconazole were 26.8%,23.7%,and 7.9%,respectively.CONCLUSION The distribution of the pathogens causing the pulmonary fungal infections in the elderly patients with tuberculosis is relatively complicated.It is necessary to choose sensitive antibiotics on the basis of the results of the drug susceptibility testing so as to raise the clinical cure rate.