COPD患者肺部真菌感染菌株分布及相关危险分析

目的探索COPD患者院内肺部真菌感染菌株分布、耐药特点及分析可能的相关危险因素。方法对2009年1月-2011年12月297例COPD患者院内肺部真菌感染标本中161株真菌菌株进行鉴定和药物敏感试验。结果161株病原菌中，念珠菌占主要地位，占86．34％，其中白色念珠菌占65．47％，药敏试验结果表明：念珠菌中氟康唑的敏感性较高。广谱高效抗生素、糖皮质激素的应用和低蛋白血症、高龄等是COPD继发真菌感染的主要危险因素。临床表现无特异性，胸部x线表现以支气管肺炎为多见。结论我院COPD患者院内肺部真菌感染病原菌以念珠菌为主。降低其继发真菌感染发病率的主要途径是避免盲目使用高效、广谱抗生素及糖皮质激素，预防医源性感染，增加患者的免疫力。

Bacterial distribution and related risk analysis of chronic obstructive pulmonary disease patients with pulmonary fungal infection

Objective To investigate the bacterial distribution of COPD patients with pulmonary fungal infection and its clinical features to improve the therapeutic effect. Methods 161 fungal strains isolated from the infected pulmonary of COPD patients were identified and given the drug sensitivity test. Results Monilia took up 86. 34% in all the indigenous bacteria, and eandida albicans took up 65.47% in monilia. The drug sensitivity test showed the monilia had a high sensitivity to flucnnazole, and the main risk factors of secondary pulmonary fungal infection were hypoproteinemia, senility, and the use of broad-spectrum antibiotic and glucoeorticoid. The clinical manifestations of secondary pulmonary fungal infection were not specific, and its X-ray features mainly showed bronchopneumonitis. Conclusion The main pathogenic bacteria of COPD patients＇ pulmonary infection is monilia, and the best way to reduce its incidence is to avoid the misuse of broad-spectrum antibiotic and glucocorticoid and to improve the patients＇ immunity at the same time.