目的 探討降階梯抗細菌治療對侵襲性肺部真菌感染( IPFI) 控制的影響。方法 納入2008 年1 月至2010 年7 月在河北醫科大學第二醫院呼吸科住院的IPFI 患者174 例, 男106 例, 女68 例。收集記錄患者的臨床資料, 包括癥狀、體征、微生物學資料、診治和預后等。將所有入選病例隨機分為降階梯治療組和非降階梯治療組, 比較在抗真菌治療同時降級使用抗細菌藥對抗真菌治療療效的影響。結果 白色念珠菌仍是最常見的致病真菌, 占總檢出菌株數的59. 7% 。抗真菌治療同時降級使用抗細菌藥治療組與未降階梯抗細菌治療患者抗真菌治療有效率差異有統計學意義( 60. 0% 比34. 5% , P =0. 001) 。結論 降級使用抗細菌藥物有助于真菌感染的控制。
【摘要】 目的 探討老年慢性阻塞性肺疾病(COPD)患者院內肺部真菌感染的可能易患因素、感染時間、臨床特征、感染常見真菌與預后。 方法 回顧性分析36例65歲以上COPD 院內肺部真菌感染患者與同期40例65歲以上COPD院內肺部非真菌感染患者的臨床資料。 結果 老年COPD患者院內肺部真菌感染的可能易患因素與長期使用廣譜抗生素、糖皮質激素,低蛋白血癥、粒細胞減少相關;吸煙時間較長及每年住院次數增多也是老年COPD患者發生院內肺部真菌感染的可能易感因素;約1/3患者肺部真菌發生在入院1~2周,臨床特征無特異性;病原菌主要為白色念珠菌(8055%),胸部X線表現以支氣管肺炎及團塊影改變為主,預后較差。 結論 老年COPD患者若長期使用廣譜抗生素和(或)糖皮質激素,有低蛋白血癥或粒細胞減少,可能會并發院內肺部真菌感染,預后較差,長期吸煙及多次住院患者也應提高警惕,重視可能易患因素并盡早采取預防與治療措施,減少死亡的發生。【Abstract】 Objective To investigate the possible risk factors of nosocomial pulmonary fungal infection, infection time, the clinical features, common infection fungal and prognosis of elderly patients with chronic obstructive pulmonary disease (COPD). Methods The clinical data of 36 patient of COPD complicated with nosocomial pulmonary fungal infection over 65 years old and 40 patients without nosocomial pulmonary fungal infection were retrospectively analyzed. Results Longterm use of broadspectrum antibiotics and (or) glucocorticoid, hypoalbuminemia, neutropenia, smoking for a long time, and hospitalizations were risk factors for nosocomial pulmonary fungal infection in elderly COPD patients. In about 1/3 of patients, nosocomial pulmonary fungal infection occurred within one to two weeks of hospitalization. The clinical features were nonspecific. Pathogens were mainly Candida albicans (8055%). Bronchial pneumonia and group block were the main findings in Chest Xray. The prognosis was poor. Conclusion Elderly patients with COPD are prone to nosocomial pulmonary fungal infection if they have hypoproteinemia, neutropenia or use longterm broadspectrum antibiotics and (or) glucocorticoids.