68例肺部真菌感染的临床与药物敏感性分析

目的：了解肺真菌感染的临床特点与常用抗真菌剂敏感性。方法：收集临床肺部疾患中误诊的肺部真菌感染病例进行临床分析，并用法国bioMerieux与丹麦Rosco公司生产试剂进行念珠菌药敏试验。结果：肺真菌病人临床症状与X线表现缺乏特异性。68例中有65例有基础病，并长期应用抗菌素或激素或细胞毒药物等治疗。真菌感染以白色念珠菌为主(70.6％),热带念珠菌与曲霉菌次之(14.7％与5.9％)。64株念珠茵对5-氟胞嘧啶、两性霉素B、制霉菌素、咪康唑、益康唑、酮康唑与氟康唑的敏感性依次为95.3％、100％、93.8％、79.7％、81.2％、82.8％与87.5％．对唑类药物有交叉耐药性。未发现白色念珠茵耐药株。结论：肺真菌病感染缺乏临床特异性,当存在基础病时，容易误诊。应尽早进行病原检查与药敏试验，去除发病危险因素,采取有针对性抗真菌治疗。

Analysis of Clinical Characteristics and Drug Sensitivity of 68 Cases Pulmonary Fungal Infections

Objective:To study the clinical characteristics of pulmonary fungal infections and sensitivity of common used antifungals. Methods Clinical analysis of misdiagnosed pulmonary fungal infection cases. The antimicrobial susceptibility of Candida strains were tested by reagent purchased from BioMerieux and Rosco. RESULTS The clinical symptom and chest radiograph of the patients with pulmonary fungal infections lacked specificity. 65 of 68 cases suffered underlying diseases and were treated with antimicrobial or hormone or cytotoxin drugs over a long period of time. The most common fungal infections were caused by Candida albicans(70.6%), followed by C. tropicalis (14.7%) and Aspergillus spp. (5.9%).The antimicrobial susceptibility of 64 Candida strains to 5-Flucytosine?Amphotenicin B?Nystatin?Miconazole?Econazole?Ketoconazole and Fluconazole were 95.3%?100%?93.8%?79.7%?81.2%?82.8% and 87.5% respectively. Azole cross resistance was found in this study. Most of C. tropicalis, C.glabrata?C. parapsilosis ?and C. krusei strains were resistant to the antimicrobial, whereas no C. albicans resistant strains were reported. CONCLUSIONS: The pulmonary fungal infections lack clinical specificity. The infected patients with underlying disease are easily misdiagnosed. Therefore, promptly identification of pathogens and testing of the drug sensitivity will get rid of risk factors for outbreak of serious disease and facilitate direct treatment of fungus infected patients