烧伤合并慢性阻塞性肺疾病患者继发真菌感染及病原菌分析

Burn combined COPD patients with secondary fungus infection incidence and related risk factors and pathogenic bacteria distribution analysis

目的探讨烧伤合并慢性阻塞性肺疾病(COPD)患者继发真菌感染发病情况及病原菌分布和相关易感因素。方法选取本院2013年6月~2016年9月收治的COPD患者800例,其中烧伤合并COPD患者37例,对患者深部痰液进行培养鉴定,分析病原菌分布情况和真菌感染对抗菌药物的耐药性,并统计患者临床症状情况,找出烧伤合并COPD继发肺部真菌感染的易感因素,对其中可能的危险因素进行多因素Logistics回归分析。结果通过痰培养共检出病原菌41株,以白色念珠菌为主(26株,63.41%);真菌对抗菌药物的耐药性由高到低依次为酮康唑(53.66%)、制霉菌素(43.9%)、氟胞嘧啶(29.27%)、两性霉素B(24.39%)、伊曲康唑(17.07%);患者主要临床症状为咳嗽(89.19%)、咳痰(70.27%)、发热(48.65%);患者年龄、住院时间、激素种类和疗程、抗菌药物种类和疗程、血浆白蛋白是烧伤合并COPD继发肺部真菌感染的相关因素;经过Logistics分析,住院时间、激素疗程、血浆白蛋白低于正常值为COPD继发肺部真菌感染的危险因素。结论烧伤合并COPD患者继发肺部真菌感染多为白色念珠菌,对COPD患者应尽快进行真菌感染检查,及早发现致病菌并进行相关治疗,暂未发现真菌感染也应做好相应预防措施。

Objective To explore burn combined Chronic Obstructive Pulmonary Disease（COPD） patients with secondary fungus infection incidence、related risk factors、pathogenic bacteria distribution. Methods Selected 800 cases of COPD patients,including burn combined 37 cases of COPD patients in our hospital from June 2013 to September 2016. Analyzed pathogenic bacteria distribution and drug resistance of fungal infection in patients with clinical symptoms,and found the COPD of secondary pulmonary fungal infection of the susceptible factors,factors of risk among multiple factors Logistics regression analysis. Results By sputum cell culture were detected pathogens,41 cases among them is given priority to with candida albicans,26 strains（63.41%） were detected;Fungi of antimicrobial resistance from high to low in turn for：ketoconazole（53.66%） and nystatin（43.9%）,fluorine cytosine（29.27%）,amphotericin B（24.39%）,itraconazole（17.07%） and ketoconazole high than other antimicrobial drug resistance. The main clinical symptoms were cough（89.19%）,expectoration（70.27%）,fever（48.65%）. Among these factors, including patients＇ age,length of hospital stay,hormone type and period of treatment,antibacterial drug kinds and treatment course of COPD,plasma albumin susceptible factors of secondary pulmonary fungal infection, we found that length of hospital stay,hormone treatment,lower plasma albumin were the risk factors for the secondary pulmonary fungal infection of COPD after logistics analysis. Conclusion Candida albicans is the common secondary fungal infection in patients with burn and COPD. Patients with COPD should be given effective prevention measurements for preventing the secondary fungal infection. Early detection and early treatment of fungal infection is very important.