肺结核患者感染真菌的药敏分析及预防措施

Drug sensitivity and preventive measures in patientswith pulmonary tuberculosis and fungal infection

  • 摘要: 目的 探讨肺结核患者继发真菌感染的药敏性,为临床采取预防措施提供指导。方法 选取2013年5月-2015年9月医院收治116例肺结核患者的临床资料,将真菌感染病例分为继发真菌感染组,其它为单纯肺结核组,各58例,统计真菌感染患者感染的真菌类型并进行药敏试验,分析患者感染真菌耐药率及引发感染的风险因素,探讨相关治疗方案和预防措施。结果 58例肺结核真菌感染患者感染部位以呼吸道为主;感染患者痰液培养出真菌72株,其中白色假丝酵母菌44株占61.11%,光滑假丝酵母菌11株占15.28%,热带假丝酵母菌8株占11.11%,近平滑假丝酵母菌3株占4.17%,曲霉菌属6株占比8.33%;白色假丝酵母菌和光滑假丝酵母菌均对5-氟胞嘧啶、伏立康唑、氟康唑、两性霉素B耐药率普遍较低<10.00%,热带假丝酵母菌对两性霉素B耐药率为0,对5-氟胞嘧啶、伊曲康唑、伏立康唑、氟康唑耐药率均>10.00%,其中氟康唑耐药率最高达到50.00%;两组患者住院时间、病程、治疗中侵入性操作、合并疾病、抗菌药物预防治疗存在显著差异,比较结果差异有统计学意义(P<0.05)。结论 肺结核继发真菌感染患者感染真菌类型繁多,其中以白色假丝酵母菌最为常见,分析感染真菌临床耐药率和感染危险因素对临床治疗和采取预防措施有一定的指导意义。

     

    Abstract: OBJECTIVE To investigate the drug sensitivity of tuberculosis fungal infection cases,so as to provide guidance for preventive measures.METHODS A total of 116 cases of tuberculosis patients from May 2013 to Sep.2015 admitted to hospital,who were divided into secondary fungal infection group and pure tuberculosis group,each with 58 cases.The fungal infection types in patients were under statistical analysis and susceptibility test.The drug-resistant infection rate and risk factors for infection were analyzed to explore the relevant treatment options and preventive measures.RESULTS The infection site of 58 cases of pulmonary tuberculosis fungal infections was mainly respiratory tract.There were 72 strains of fungi cultured from the sputum,in which Candida albicans44 strains accounting for 61.11%,Glabrata11 strains 15.28%,Candida tropicalis 8strians 11.11%,Candida parapsilosis 3strains 4.17%,Aspergillus 6strains 8.33%.Candida albicans and Candida glabrata had resistance rates less than 10.00% to 5-fluoro-cytosine,iraq itraconazole,voriconazole,fluconazole,amphotericin B.Candida tropicalis had 0.00% resistant to amphotericin B,but to 5-fluoro cytosine,itraconazole,voriconazole,fluconazole more than 10.00%,in which the fluconazole reached 50.00%.Two groups of the patients hospital stay,course of the disease,invasive procedures in treatment,complicated and antimicrobial drug prevention had significant difference(P<0.05).CONCLUSION There were various fungal infection types in patients with tuberculosis,and Candida albicans is the most common one.The analyzes of clinical fungal infection rate and risk factors for infection resistant to clinical treatment and preventive measures have a certain significance.

     

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