Risk factors and drug sensitivity in pulmonary tuberculosis complicated by fungal infection

ZHANG Wei; JIANG Jun; HE Jian; LIU Li-li

Abstract：Objective To investigate the risk factors and drug sensitivity in pulmonary tuberculosis complicated by fungal in-fection, so as to provide evidence for the prevention, diagnosis and treatment of the disease. Methods A total of 179 patients with pulmonary tuberculosis admitted to our hospital from May 2011 to May 2012 were selected, and divided into a non-fungal infection group (n=108) and a fungal infection group (n=71). The clinical features of the two groups were analyzed. Yeast chromogenic medi-um was used to judge the strains, and ROSCO disk diffusion method was used to test drug sensitivity. Results The risk factors of pulmonary tuberculosis complicated by fungal infection were secondary pulmonary tuberculosis, retreatment, sputum smears negative for acid-fast bacilli, long-term use of corticosteroids and broad-spectrum antibiotics, and combination with underlying diseases ( OR≥2). The main fungus causing pulmonary fungal infection was Candida (87.32%), of which Candida albicans had a low drug resistance, only 7 strains resistant to 5-flucytosine; of 10 strains of Candida tropicalis, 2 were resistant to econazole and 2 to amphotericin B;Candida glabrata was only sensitive to itraconazole. Conclusions Prevention and treatment of pulmonary fungal infection should be paid much attention to in patients with secondary pulmonary tuberculosis, retreatment, long-term use of corticosteroids and broad-spectrum antibiotics, and combination with underlying diseases. Sputum smears negative for acid-fast bacilli can be used as a sensi-tive indicator for early diagnosis of pulmonary fungal infection. For pulmonary tuberculosis patients with fungal infection, drug sus-ceptibility testing should be given, and the best antifungal drugs be selected. Patients with Candida glabrata should be given an alert on.