2015-2019年甘肃医学院附属医院慢性阻塞性肺疾病急性加重期患者继发肺部真菌感染率趋势及耐药性分析

目的 了解2015-2019年甘肃医学院附属医院慢性阻塞性肺疾病急性加重期（AECOPD）患者继发肺部真菌感染率变化趋势、分布及耐药性特点。方法 提取2015-2019年甘肃医学院附属医院AECOPD患者临床真菌分离及药敏相关数据。结果 2015-2019年AECOPD患者继发肺部真菌感染率为13.37%，且呈上升趋势，真菌感染率从2015年的10.88%上升至2019年的15.71%；共分离出6种真菌，以白色念珠菌（52.41%）、光滑念珠菌（25.13%）、热带念珠菌（12.30%）、曲霉菌（8.02%）为主；主要以真菌与细菌的混合感染存在（64.61%），其中以真菌与革兰阴性菌混合感染为主（70.43%）。氟康唑对各种念珠菌耐药率接近30%，对曲霉菌耐药率大于90%，伏立康唑和两性霉素B对各种念珠菌和曲霉菌的耐药率较小。结论 真菌感染在AECOPD患者中呈明显增长趋势，白色念珠菌、光滑念珠菌、热带念珠菌和曲霉菌常见，且主要为与细菌混合感染存在，氟康唑对真菌耐药率较高，伏立康唑成为治疗真菌感染的首选。

Trend of pulmonary fungal infection rate and drug resistance in patients with AECOPD in Affiliated Hospital of Gansu Medical College from 2015 to 2019

Objective To investigate the trend of pulmonary fungal infection rate and drug resistance in patients with AECOPD in Affiliated Hospital of Gansu Medical College from 2015 to 2019. Methods According to the data on clinical isolates and drug susceptibility from 2015 to 2019 in Affiliated Hospital of Gansu Medical College, the distribution characteristics and the resistance profile of fungi were analyzed, as well as the trend. Results From 2015 to 2019, the incidence of pulmonary fungal infection in AECOPD patients was 13.37%, and it was on the rise. The infection rate increased from 10.88% (2015) to 15.71% (2019). Six fungi were isolated, mainly were Candida albicans (52.41%), Candida glabrata (25.13%), Candida tropicalis (12.30%), and Aspergillus (8.02%). Fungal infection mainly was mixed infection with bacteria (64.61%), in which fungi and Gram-negative bacteria mixed infection (70.43%). The resistance rate of fluconazole to various Candida were near to 30%, and to Aspergillus was more than 90%, and the resistance rate of voriconazole and amphotericin B to various Candida and Aspergillus were lower. Conclusion Fungal infections shows a significant growth trend in AECOPD patients. C. albicans, C. glabrata, C. tropicalis, and Aspergillus are common, and mainly mixed with bacteria. Fluconazole has a high resistance rate to fungi, and voriconazole is the first choice for the treatment of fungal infections.