1例呼吸道标本中白色念珠菌阳性的鉴别诊断与药物治疗分析

Anti-fungal therapy of patients with positive candida albicans in respiratory tract specimen: a case report

目的 :探讨呼吸道标本白色念珠菌培养阳性时,定植与感染的判断手段及抗真菌治疗的合理使用。方法:结合1例长期口服糖皮质激素、呼吸道标本中白色念珠菌阳性的社区获得性肺炎病例,通过文献检索与复习,为合理的抗真菌治疗寻找证据。结果与结论:尽管该患者呼吸道标本中白色念珠菌呈阳性,但通过临床预测规则及念珠菌定植指数判断其定植可能性大,停用抗真菌治疗并未对其疾病转归产生影响。对于呼吸道标本白色念珠菌阳性的患者,基于证据、利用多种手段及时判断其为定植或感染,不仅能避免过度治疗,也能保证抢先治疗的及时开展,促进抗真菌药物的合理使用。

Objective： To investigate the available measures to identify the colonization or infection of candida albicans when the growth of candida from respiratory tract secretions is confirmed, and promote the rational use of antifungal drugs. Methods： One patient in long-term immune-suppression state who was diagnosed as community acquired pneumonia with candida growth in the sputum was reported and analyzed. The evidence for rational use of antifungal agents was gathered through literature review. Results and Conclusion： Although candida was identified in the patient＇s respiratory tract specimen, it was more likely to be colonization rather than infection according to the clinical prediction rule and candida colonization index. Discontinuation of antifungal therapy had no effect on the prognosis of the patient＇s infection. It is rational to identify the colonization of candida when the respiratory culture result is positive, which is essential to avoid overtreatment, ensure preemptive antifungal therapy and promote rational use of antifungal agents.