COPD合并继发肺部真菌感染患者病原菌分布及其耐药情况分析  

Analysis of Distribution and Drug Resistance of Pathogens in Patients with COPD Complicated with Secondary Pulmonary Fungal Infection

作　　者：周璐 黄建 ZHOU Lu;HUANG Jian(Wuxi Rehabilitation Hospital,Wuxi 214000,China;不详)

机构地区：[1]无锡市康复医院,江苏无锡214000

出　　处：《中外医学研究》2022年第32期172-176,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:分析慢性阻塞性肺疾病(COPD)合并继发肺部真菌感染患者病原菌分布及其耐药情况。方法:选取无锡市康复医院2018年10月-2020年10月收治的COPD合并继发肺部真菌感染患者80例作为研究对象,对其深部痰液标本采集培养并鉴定菌种,进行药敏试验并根据结果进行用药调整,观察患者临床转归情况。结果:COPD继发肺部真菌感染患者主要临床表现为发热、咳嗽、干啰音、湿啰音、咳痰、痰中带血、胸痛等,分别占85.00%、83.75%、83.75%、73.75%、67.50%、60.00%、57.50%。80例患者共检出8类病原菌,其中以白色念珠菌为主要菌株构成,构成比为47.50%,克柔念珠菌及热带念珠菌均有一定检出比例,构成比分别为17.50%、13.75%,其他菌群检出较少,均在10.00%以下。各菌株对伊曲康唑、酮康唑、氟康唑的耐药率均处于较高水平,其中克柔念珠菌、热带念珠菌、光滑念珠菌、黄曲霉、毛霉菌对伊曲康唑耐药率均>30%,白色念珠菌、黄曲霉、毛霉菌、酵母样真菌、烟曲霉对酮康唑耐药率均>30%;各菌株对两性霉素B及制霉菌素耐药率均<10%,较为敏感。患者经两性霉菌B+制霉菌素治疗总有效率为92.50%,死亡率为7.50%,不良反应发生率为26.25%。结论:COPD合并继发肺部真菌感染患者侵袭菌种主要是以白色念珠菌为常见菌的念珠菌属,且对伊曲康唑、酮康唑、氟康唑等耐药性处于较高水平,临床在调整用药时需考虑新方案的安全性。Objective:To analyze the distribution and drug resistance of pathogens in patients with chronic obstructive pulmonary disease(COPD)complicated with secondary pulmonary fungal infection.Method:A total of 80 COPD patients with secondary pulmonary fungal infection in Wuxi Rehabilitation Hospital from October 2018 to October 2020 were selected as the research objects,the sputum samples were collected,cultured and identified,the drug sensitivity test was carried out,and the medication was adjusted according to the experimental results,and the clinical outcomes of patients were observed.Result:The main clinical manifestations of COPD patients with secondary pulmonary fungal infection were fever,cough,dry rales,wet rales,expectoration,blood in sputum,chest pain and so on,accounting for 85.00%,83.75%,83.75%,73.75%,67.50%,60.00%,57.50%respectively.Eight kinds of pathogenic bacteria were detected in 80 patients,of which Candida Albicans was the main strain,with the constituent ratio of 47.50%.Candida Krusei and Candida Tropicalis were detected in certain proportion,with the constituent ratio of 17.50%and 13.75%respectively.The detection rate of other bacterial groups was less than 10.00%.The resistance rates of Candida Krusei,Candida Tropicalis,Candida Glabrata,Aspergillus Flavus and Mucor to Itraconazole were more than 30%.The resistance rates of Candida albicans,Aspergillus flavus,Mucor,Candida Albicans to Ketoconazole were more than 30%.The resistance rates of all strains to Amphotericin B and Nystatin were less than 10%,more sensitive.The total effective rate and mortality rate of patients treated with Amphotericin B+Nystatin were 92.50%and 7.50%respectively,and the total incidence of adverse reactions was 26.25%.Conclusion:Candida Albicans is the most common invasive bacteria in COPD patients with secondary pulmonary fungal infection,and the drug resistance to Itraconazole,Ketoconazole and Fluconazole are at a high level,the safety of new regimen should be considered in clinical medication adjustment.

关 键 词：慢性阻塞性肺疾病 真菌感染 耐药性 念珠菌 

分 类 号：R563[医药卫生—呼吸系统] R446.5[医药卫生—内科学]