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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。
Objective To investigate the susceptibility of patients with pulmonary tuberculosis secondary to fungal infection and provide guidance for preventive measures in clinical practice. Methods From May 2013 to September 2015, clinical data of 116 patients with pulmonary tuberculosis admitted to the hospital were collected. The cases of fungal infection were divided into secondary fungal infection group and the others were simple pulmonary tuberculosis group, the other 58 were infected with fungal Type and susceptibility testing, analysis of patients infected with fungal resistance and risk factors for infection, to explore the relevant treatment options and preventive measures. Results Of the 58 patients with pulmonary fungal infection, respiratory tract was the main infection area. 72 strains of fungi were infected with sputum from infected patients, among which 44 strains of Candida albicans accounted for 61.11%, 11 strains of Candida glabrata accounted for 15.28% 8 strains of yeast accounted for 11.11%, 3 of Candida parapsilosis accounted for 4.17%, 6 strains of Aspergillus accounted for 8.33%; Candida albicans and Candida glabrata were 5-fluorocytosine, voriconazole , Fluconazole, amphotericin B generally lower resistance rate <10.00%, Candida tropicalis resistance to amphotericin B was 0, 5-fluorocytosine, itraconazole, voriconazole, fluorine The drug resistance rates of all the two groups were all higher than 10.00%, and the highest rate of fluconazole was 50.00%. There was significant difference in the duration of hospitalization, duration of disease, invasive operation in treatment, combined disease and prevention and treatment of antimicrobial agents in both groups. There was statistical significance (P <0.05). Conclusions There are many types of fungi infection in patients with secondary fungal infection of pulmonary tuberculosis, of which Candida albicans is the most common. Analyzing the clinical drug resistance rate and risk factors of infection may provide some guidance for clinical treatment and preventive measures.