Clinical Characteristics And Influencing Factors Of Pulmonary Fungal Infection In Severe Patients In Respiratory And Critical Care Medicine Department

Objective:To analyze the clinical characteristics,risk factors,etiology and drug sensitivity test of pulmonary fungal infection in severe patients in respiratory and critical care medicine department of a third grade a hospital.Methods:A retrospective analysis was conducted to select 182 patients with severe illness who met the inclusion criteria from the Respiratory and Critical Care Medicine Department of a Grade A hospital from January 1,2015 to December 31,2019,including 90 patients with pulmonary fungal infection(confirmed and clinically diagnosed)and the rest 92 patients in the control group.The general data,clinical characteristics,imaging changes,etiology and other clinical data of the patients were summarized and analyzed,and Logistic multifactor regression was used to analyze the related risk factors of pulmonary fungal infection.Results:1.The clinical manifestations of severe patients with fungal infection mainly included cough,sputum,dyspnea,fever,pulmonary rales,hemoptysis,etc.,which showed no difference compared with the control group.There were 60 cases of double lung disease,16 cases were on the right side and 14 cases were on the left side.The imaging manifestations included patchy exudation,consolidation,pleural effusion,bronchiectasis,nodular shadow,cavity,air crescent,halo sign and so on.2.Specimen source:2 confirmed patients were diagnosed by bronchoscopic biopsy.Among 88 clinical diagnoses,65 cases were detected by sputum culture,12 cases were detected by bronchoalveolar lavage fluid culture,and 11 cases were detected by sputum culture combined with blood G test and GM test.Pathogenic bacteria:83 cases(92.2%)were infected with one kind of fungi,among which 43 cases(47.8%)were Candida albicans,13 cases(14.4%)were Aspergillus,11 cases(12.2%)were tropical and subtropical candida candida,7 cases(7.8%)were candida glabra,6 cases(6.7%)were Candida clorus.Other 3 cases(3.3%)and 7 cases(7.8%)were infected with two kinds of fungi.3.Multivariate Logistic analysis showed that chronic obstructive pulmonary disease,mechanical ventilation,central venous catheter,duration of glucocorticoid use,duration of broad-spectrum antibiotics use and hypoproteinemia were independent risk factors for pulmonary fungal infection in patients with severe respiratory and critical care.4.Drug sensitivity test analysis:Candida albicans was sensitive to fluconazole,5-fluorocytosine,itraconazole and voriconazole,and other bacteria had different degrees of drug resistance to some of the above four drugs.Conclusion:Most patients with pulmonary fungal infection in respiratory and critical care medicine department did not use immunosuppressive agents,AIDS,trauma and other host factors,and there was no difference in clinical characteristics between the fungal infection group and the control group.Candida albicans was the first pathogen,followed by Aspergillus.In the clinical treatment of severe pulmonary infection,it is necessary to guard against fungal infection in patients with poor anti-bacterial treatment.Among them,chronic obstructive pulmonary disease,central venous catheter,mechanical ventilation,duration of glucocorticoid use,duration of broad-spectrum antibiotics use and hypoproteinemia were independent risk factors for pulmonary fungal infection in patients with severe respiratory and critical care.For patients with severe pulmonary infection with the above risk factors,combined with clinical and microbial evidence,early and timely diagnosis is particularly important for drug selection,which directly affects the prognosis of patients and reduces the fatality rate.