肺部真菌感染的临床特点及耐药性研究

目的 回顾性分析本院肺部真菌感染患者的临床特点、病原学分布及体外药敏试验结果,为预防及控制肺部真菌感染提供临床及实验室依据.方法 调查确诊或临床诊断为侵袭性肺部真菌感染病例507例,收集患者深部咯痰、气管导管吸出物、支气管镜套管吸出物及胸腔积液等标本,行真菌培养、分离、鉴定分型及体外药敏试验.结果 共分离真菌576株,其中白色念珠菌(377株,65.5%)仍为肺部真菌感染的主要致病菌,非白色念珠菌热带念珠菌(10.8%)、近平滑念珠菌(6.8%)等]的检出率有所增加(P＜0.05);本组患者中基础疾病以慢性阻塞性肺疾病(43.6%)、恶性肿瘤(11.6%)、脑出血(10.1%)、重型颅脑损伤(9.7%)及肺结核(6.1%)为主;真菌感染的可能相关因素为广谱抗生素的长期应用、低蛋白血症、高龄(年龄≥60岁)、长期使用糖皮质激素及深静脉置管、气管插管、气管切开和机械通气等有创性治疗.体外药敏试验提示对真菌耐药率较低的抗真菌药物为两性霉素B、伊曲康唑及5-氟胞嘧啶,而本组主要念珠菌对氟康唑及酮康唑的耐药性均有明显升高(P＜0.05).结论 本院肺部真菌感染呈增加趋势,对现有氟康唑及酮康唑的耐药性均有明显升高,值得临床重视.

Analysis of pathogens and drag sensitivity test in lung fungal infection

Objective To investigate the distribution of pathogens and drug sensitivity in airway fungal infection.Methods A total of 507 patients with acquired fungal infection were investigated.Specimens of deep expectoration,aspiration of the endotracheal tube,bronchoscopy aspiration and pleural effusion were collected for fungal culture,separation,identification and in vitro drug sensitivity test.Results 576 strains of fungi were isolated.Candida albicans(377,65.5%)remained the main pulmonary fungal infection pathogens.Separation rate of non-Candida albicans(Candida tropicalis 10.8%,Candida parapsilosis 6.8%)increased(P＜0.05).Primary diseases in these patients were chronic obstructive pulmonary disease (43.6%),cancer(11.6%),cerebral hemorrhage(10.1%),severe brain injury(9.7 0A)and tuberculosis (6.1 %).Fungal infection may be related to the factors:long-term application of broad-spectrum antibiotics,hypoproteinemia,senior citizens(≥60 years old),long-term use of glucocorticoids,invasive treatment,such as deep venous catheter,endotracheal intubation,tracheotomy and mechanical ventilation,ete.In vitro experiments showed low rate of resistance to the antifungal amphotericin B,itraconazole and 5-fluorocytosine,and the resistance to fluconazole and ketoconazole increased(P＜0.05).Conclusions Lung fungal infection tends to increase in recent years and the drug resistance to fluconazole and ketoconazole has increased,which worths more clinical attention.