肺结核患者真菌感染的临床特点及耐药性分析

Clinical characteristics of fungal infections in tuberculosis patients and analysis of drug resistance

目的分析肺结核患者真菌感染分布及耐药性特点,为临床诊断与治疗提供参考依据。方法选取2012年1月-2015年1月医院肺结核患者3 142例为调查对象,收集痰标本,进行真菌培养和鉴定,并进行药敏试验。结果 3 142例肺结核患者真菌感染150例,感染率为4.77%,其中,浸润性肺结核感染率为4.65%,纤维空洞型肺结核感染率为16.67%,血性播散型肺结核感染率为7.31%;150例真菌中,白色念珠菌占75.33%,热带念珠菌占8.67%,光滑念珠菌占7.33%,克柔念珠菌占5.33,其他占3.33%;白色念珠菌、热带念珠菌以及光滑念珠菌对抗真菌药物耐药性较低,克柔念珠菌对抗真菌药物耐药性较高,在五种抗真菌药物中,氟康唑耐药性较高。结论真菌感染主要以白色念珠菌感染为主,对药物敏感性较高,临床上要根据药敏试验结果对患者进行药物选择治疗。

OBJECTIVE To investigate the distribution and drug resistance of fungi causing fungal infections in tuberculosis patients so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 3 142 tuberculosis patients who were treated in hospitals from Jan 2012 to Jan 2015 were recruited as the study objects,the sputum specimens were collected The fungi were cultured and identtfied,and the drug susceptibility testing was performed.RESULTS Of the 3 142 tuberculosis patients,150 had fungal infections,with the infection rate4.77%;the infection rate was 4.65%in the patients with infiltrative tuberculosis,16.67%in the patients with fibrocavitary tuberculosis,7.31%in the patients with hematogenous disseminated tuberculosis.Among the fungi isolated from the 150 patients with fungal infections,the Candida albicans accounted for 75.33%,the Candida tropicalis accounted for 8.67%,the Candida glabrata accounted for 7.33%,the Candida krusei accounted for5.33% and other species accounted for 3.33%.The drug resistance rates of the C.albicans,C.tropicalis,and C.glabratato the antifungal agents were relatively low,the C.krusei was highly resistant to the antifungal agents,and the drug resistance rate was higher to fluconazole than to other four antifungal agents.CONCLUSIONThe C.albicansis dominant among the fungi causing the fungal infections and is highly susceptible to drugs.It is necessary for the hospital to conduct the drug therapy based on the results of the drug susceptibility testing.