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目的分析郑州市某社区进行调研,检测社区慢性阻塞性肺疾病(COPD)患者肺部真菌感染病原菌和耐药性并探讨其危险因素。方法选取本院附近某社区COPD患者916例,将其中出现真菌感染的136例患者设为感染组,未出现肺部感染的780例患者设为非感染组。收集感染组患者痰液标本进行真菌培养、分离和鉴定;采用纸片扩散法检测抗菌药物敏感性;记录两组患者医院就诊情况及临床资料,分析相关危险因素。结果 COPD患者肺部真菌感染率为14.85%,共检出真菌162株,其中白假丝酵母菌比例最高且明显高于其他菌株,差异有统计学意义(P<0.05)。药敏结果显示,氟康唑和伊曲康唑的耐药率均≥60%;两性霉素B、氟胞嘧啶、美帕曲星、克霉灵的耐药率均<30%。多因素Logistic回归分析显示,合并糖尿病、血浆白蛋白偏低、长期使用抗菌药物是COPD患者肺部真菌感染的危险因素。结论郑州某社区COPD患者肺部真菌感染以白假丝酵母菌为主,对氟康唑和伊曲康唑耐药率高;糖尿病、低血浆白蛋白、抗菌药物长期使用是导致COPD的主要危险因素。
Objective To analyze a community in Zhengzhou to investigate the pathogenic fungi and drug resistance of pulmonary fungal infection in patients with chronic obstructive pulmonary disease (COPD) and to explore the risk factors. Methods A total of 916 patients with COPD in a community near our hospital were enrolled. 136 patients with fungal infection were selected as infection group, and 780 patients without pulmonary infection were selected as non-infected group. Sputum specimens of infected patients were collected for fungal culture, isolation and identification. Antibiotic susceptibility was tested by disk diffusion method. The hospital attendance and clinical data of two groups of patients were recorded and relevant risk factors were analyzed. Results The pulmonary fungal infection rate in COPD patients was 14.85%. 162 fungi were detected, of which Candida albicans was the highest and significantly higher than other strains (P <0.05). Drug susceptibility results showed that the drug resistance rates of fluconazole and itraconazole were all ≥60%. The resistance rates of amphotericin B, flucytosine, meclizine and ketamine were both less than 30%. Multivariate logistic regression analysis showed that with diabetes, low plasma albumin, long-term use of antimicrobial agents is a risk factor for pulmonary fungal infection in COPD patients. Conclusions Pulmonary fungal infections in a community with COPD in Zhengzhou are mainly Candida albicans, with high rates of fluconazole and itraconazole. Diabetes mellitus, low serum albumin, long-term use of antimicrobial agents are the main risk of COPD factor.