慢性阻塞性肺疾病患者继发真菌性肺炎的特点及耐药情况

目的探讨慢性阻塞性肺疾病患者继发真菌性肺炎的真菌分布特点和耐药情况。方法分析2010年10月至2015年10月收治的60例慢性阻塞性肺疾病且伴有继发性真菌感染肺炎的患者的真菌感染情况。另选60例慢性阻塞性肺疾病无真菌感染的患者作为对照分析影响真菌感染的危险因素。结果 60例慢性阻塞性肺疾病且伴有继发性真菌感染肺炎患者的呼吸道分泌物样本中共检出475株真菌,其中主要为白色念珠菌,占63.58%。5种常用的抗真菌药物的抗菌活性不同,其中抗菌活性最好的是两性霉素B和伊曲康唑。经过统计分析后发现高龄、机械通气、长时间入住ICU、长期使用抗生素和糖皮质激素以及两种以上器官功能衰竭等是影响慢性阻塞性肺疾病患者继发真菌性肺炎的独立危险因素。结论慢性阻塞性肺疾病且伴有继发性真菌感染肺炎主要为感染白色念珠菌,抗真菌药物活性最好的是两性霉素B和伊曲康唑。对于此类患者应尽早发现病原性真菌、选择合适的抗真菌药物同时减少影响继发真菌感染的危险因素。

Distribution and drug resistance of pathogenic bacteria of COPD patients complicated with fungal pneumonia

Objective To explore the fungus distribution and drug resistance of secondary fungus infection after chronic obstructive pulmonary disease ( COPD) . Methods The clinical data of 60 COPD patients with second-ary pulmonary fungal infection from September 2010 to September 2015 were retrospectively analyzed. Moreover, 60 COPD patients with no fungal infection were selected as the control group. The risk factors of COPD patients compli-cated with fungal pneumonia were analyzed. Results Among the 60 cases of COPD with secondary infection, 475 strains of fungi were detected, in which Candida albicans species ranked first ( 63. 58%) . Seven kinds of common anti-fungal drugs showed different antibacterial activity against these fungal strains, especially amphotericin B and itraconazole. Statistical analysis showed that the risk factors included elder, mechanical ventilation, living in ICU too long, long-term use of antibiotics and glucocorticoids and two or more organ failure patients with chronic obstructive pulmonary disease. Conclusion Candida albicans are the major pathogens of COPD patients with secondary fungus pneumonia infection. Amphotericin B and itraconazole have the best anti-fungal activity. Pathogenic fungi for such patients should be found as early as possible, and the appropriate anti-fungal drugs should be chosen. At the same time, the risk factors of secondary fungus infection should be reduced.