新生隐球菌感染现状与相关抗菌药物使用
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摘要
目的分析近年来医院新生隐球菌感染现状以及肺隐球菌病患者抗菌药物的使用情况。方法纳入2012年10月1日~2017年9月30日南京医科大学第一附属医院新生隐球菌感染住院患者66例,回顾性分析该类患者流行病学资料,抗菌药物使用以及新生隐球菌荚膜抗原检测等。肺隐球菌病患者与细菌性肺炎患者按照1︰1配比进行病例对照研究(各11例),比较两组患者的住院总天数、抗菌药物使用天数、住院总费用及抗菌药物费用等。结果连续5年内本院共确诊新生隐球菌感染者66例,平均年龄(47±13)岁。感染部位以肺部和中枢神经系统为主。31例患者进行新生隐球菌荚膜抗原检测,其中阳性例数23,阳性率为74.19%。排除入院已确诊及其他部位感染者后,肺隐球菌病患者33例,诊断明确前抗菌药物使用率为87.88%,联合抗菌药物使用率为63.64%。肺部隐球菌组患者住院总天数和住院总费用分别为(18±8) d和17 107.6元,较细菌性肺炎组[(10±3)d和8 731.9元]均显著增加,差异具有统计学意义(t=3.145、P=0.012,Z=-2.803、P=0.005);但病例组患者抗菌药物使用天数、抗菌药物费用[(11±5)d、(3 462.6±2 277.1)元]与对照组[(10±3)d和4 044.7±1 898.9)元],差异无统计学意义(t=0.745、P=0.475,Z=-0.968、P=0.333)。肺隐球菌病组抗菌药物使用强度为70.98 DDDs·100人-1·d-1。结论近年来本院新生隐球菌感染部位以肺部和中枢神经系统为主;肺隐球菌病患者诊断明确前以及整个诊疗过程均存在抗菌药物使用不合理的现象。
Objective To analyze the infectious status of nosocomial Cryptococcus neoformans in recent years and to explore the use of antibacterial drugs in patients with pulmonary cryptococcosis. Methods Data of patients with Cryptococcus neoformans infection in the First Affiliated Hospital of Nanjing Medical University enrolled from October 1 st 2016 to September 30 th 2017 were collected. The epidemiological data, using of antibacterial agents and results of cryptococcal polysaccharide antigen detection were analyzed, retrospectively. A case-control study was conducted between patients with pulmonary cryptococcosis and bacterial pneumonia according to the 1︰1 ratio(11 cases each). The total period of hospitalization and antibacterial drug use, total expenses of hospitalization and antibacterial drug were compared between the two groups, respectively. ResultsWithin 5 years, a total of 66 cases with Cryptococcus neoformans were diagnosed, with an average age of(47 ± 13) years old. The infection sites were mainly lung and central nervous system. Thirty-one cases were detected for Cryptococcus neoformans capsule antigen, among which 23 cases were positive, with the positive rate of 74.19%. Thirty-three patients with pulmonary cyptococcosis were excluded after definite diagnosis and infection of other parts on admission. About 87.88% cases had taken antibacterial drugs before the diagnosis was confirmed, while 63.64% cases had taken combined antibacterial drugs. The total period in hospital and cost of hospitalization in the pulmonary cyptococcosis group were(18 ± 8) d and 17 107.6 yuan, respectively, which were significantly higher than those in the bacterial pneumonia group [(10 ± 3) d and 8 731.9 yuan], with significant differences(t = 3.145, P = 0.012; Z =-2.803, P = 0.005). But the period of antibacterial drug use [(11 ± 5) d vs.(10 ± 3)d] and the cost of antibacterial drug [(3 462.6 ± 2 277.1) yuan vs.(4 044.7 ± 1 898.9) yuan] in both groups were not significantly different(t = 0.745, P = 0.475; Z =-0.968, P = 0.333). The intensity of antibacterial drug use in the pulmonary cryptococcosis group was 70.98 DDDs per 100 people one day. Conclusions In recent years, the infection site of Cryptococcus neoformans in our hospital is mainly in lung and central nervous system, and the use of antimicrobial drugs is unreasonable before and during the diagnosis and treatment of Cryptococcus neoformans infection.
Objective To analyze the infectious status of nosocomial Cryptococcus neoformans in recent years and to explore the use of antibacterial drugs in patients with pulmonary cryptococcosis. Methods Data of patients with Cryptococcus neoformans infection in the First Affiliated Hospital of Nanjing Medical University enrolled from October 1 st 2016 to September 30 th 2017 were collected. The epidemiological data, using of antibacterial agents and results of cryptococcal polysaccharide antigen detection were analyzed, retrospectively. A case-control study was conducted between patients with pulmonary cryptococcosis and bacterial pneumonia according to the 1︰1 ratio(11 cases each). The total period of hospitalization and antibacterial drug use, total expenses of hospitalization and antibacterial drug were compared between the two groups, respectively. ResultsWithin 5 years, a total of 66 cases with Cryptococcus neoformans were diagnosed, with an average age of(47 ± 13) years old. The infection sites were mainly lung and central nervous system. Thirty-one cases were detected for Cryptococcus neoformans capsule antigen, among which 23 cases were positive, with the positive rate of 74.19%. Thirty-three patients with pulmonary cyptococcosis were excluded after definite diagnosis and infection of other parts on admission. About 87.88% cases had taken antibacterial drugs before the diagnosis was confirmed, while 63.64% cases had taken combined antibacterial drugs. The total period in hospital and cost of hospitalization in the pulmonary cyptococcosis group were(18 ± 8) d and 17 107.6 yuan, respectively, which were significantly higher than those in the bacterial pneumonia group [(10 ± 3) d and 8 731.9 yuan], with significant differences(t = 3.145, P = 0.012; Z =-2.803, P = 0.005). But the period of antibacterial drug use [(11 ± 5) d vs.(10 ± 3)d] and the cost of antibacterial drug [(3 462.6 ± 2 277.1) yuan vs.(4 044.7 ± 1 898.9) yuan] in both groups were not significantly different(t = 0.745, P = 0.475; Z =-0.968, P = 0.333). The intensity of antibacterial drug use in the pulmonary cryptococcosis group was 70.98 DDDs per 100 people one day. Conclusions In recent years, the infection site of Cryptococcus neoformans in our hospital is mainly in lung and central nervous system, and the use of antimicrobial drugs is unreasonable before and during the diagnosis and treatment of Cryptococcus neoformans infection.
引文
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[17]赵微,金芬华,陈良安.解放军总医院20年肺隐球菌病分析[J].解放军医学院学报,2014,35(4):549-551.
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[19]吕群.乳胶凝集试验对肺隐球菌病诊断价值的Meta分析[J].中华全科医学,2017,15(3):521-523.
[20]王葆青,张含之,范壁君,等.中国大陆地区肺隐球菌病临床表现的Meta分析[J].中国临床医学,2013,20(3):351-354.
[21]叶健魁,王艳丽,王艳丽,等.隐球菌病69例临床分析[J].南京医科大学学报(自然科学版),2017,37(9):1200-1204.
[22]Prestinaci F,Pezzotti P,Pantosti A.Antimicrobial resistance:a global multifaceted phenomenon[J].Pathog Glob Health,2015,109(7):309-318.
[23]肖永红.国家细菌耐药控制行动计划:基于大健康理念的耐药控制宏图[J].中华临床感染病杂志,2016,9(4):289-293.
[24]Thiessen K,Lloyd AE,Miller MJ,et al.Assessing guidelineconcordant prescribing for community-acquired pneumonia[J].Int JClin Pharm,2017,39(4):674-678.
[25]May RC,Stone NR,Wiesner DL,et al.Cryptococcus:from environmental saprophyte to global pathogen[J].Nat Rev Microbiol,2016,14(2):106-117.
[2]Park BJ,Wannemuehler KA,Marston BJ,et al.Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS[J].AIDS,2009,23(4):525-530.
[3]Chowdhary A,Rhandhawa HS,Prakash A,et al.Environmental prevalence of Cryptococcus neoformans and Cryptococcus gattii in India:an update[J].Crit Rev Microbiol,2012,38(1):1-16.
[4]Litvintseva AP,Carbone I,Rossouw J,et al.Evidence that the human pathogenic fungus Cryptococcus neoformans var.grubii may have evolved in Africa[J].PLoS One,2011,6:e19688.
[5]Chang CC,Sorrell TC,Chen SC.Pulmonary Cryptococcosis[J].Semin Respir Crit Care Med,2015,36(5):681-691.
[6]Perfect JR,Bicanic T.Cryptococcosis diagnosis and treatment:What do we know now?[J].Fungal Genet Biol,2015,78:49-54.
[7]梅周芳,秦欣宇,潘星月,等.无免疫功能缺陷的肺隐球菌病19例误诊分析[J].临床误诊误治,2016,29(1):50-52.
[8]Karam G,Chastre J,Wilcox MH,et al.Antibiotic strategies in the era of multidrug resistance[J].Crit Care,2016,20(1):1-9.
[9]《中国真菌学杂志》编辑委员会.隐球菌感染诊治专家共识[J].中国真菌学杂志,2010,5(2):65-67.
[10]Ruan Q,Zhu Y,Chen S,et al.Disseminated cryptococcosis with recurrent multiple abscesses in an immunocompetent patient:a case report and literature review[J].BMC Infect Dis,2017,17(1):369.
[11]Vallabhaneni S,Mody RK,Walker T,et al.The global burden of fungal diseases[J].Infect Dis Clin North Am,2016,30(1):1-11.
[12]兰长青,翁恒,李红艳,等.肺隐球菌病117例回顾分析[J].中华结核和呼吸杂志,2016,39(11):862-865.
[13]Yuchong C,Fubin C,Jianghan C,et al.Cryptococcosis in China(1985-2010):review of cases from Chinese database[J].Mycopathologia,2012,173(5-6):329-335.
[14]张含之.中国大陆地区肺隐球菌病文献Meta分析[D].上海:复旦大学内科学(呼吸科),2009:36-37.
[15]刘仁水,郑大伟,唐小丽,等.经皮肺穿刺活检术对无反应肺炎的价值[J].临床肺科杂志,2017,22(10):1919-1920.
[16]Maziarz EK,Perfect JR.Cryptococcosis[J].Infect Dis Clin NAm,2016,30(1):179-206.
[17]赵微,金芬华,陈良安.解放军总医院20年肺隐球菌病分析[J].解放军医学院学报,2014,35(4):549-551.
[18]Arechavala A,Negroni R,Messina F,et al.Cryptococcosis in an infectious diseases hospital of Buenos Aires,Argentina.Revision of 2 041 cases:Diagnosis,clinical features and therapeutics[J].Rev Iberoam Micol.2018,35(1):1-10.
[19]吕群.乳胶凝集试验对肺隐球菌病诊断价值的Meta分析[J].中华全科医学,2017,15(3):521-523.
[20]王葆青,张含之,范壁君,等.中国大陆地区肺隐球菌病临床表现的Meta分析[J].中国临床医学,2013,20(3):351-354.
[21]叶健魁,王艳丽,王艳丽,等.隐球菌病69例临床分析[J].南京医科大学学报(自然科学版),2017,37(9):1200-1204.
[22]Prestinaci F,Pezzotti P,Pantosti A.Antimicrobial resistance:a global multifaceted phenomenon[J].Pathog Glob Health,2015,109(7):309-318.
[23]肖永红.国家细菌耐药控制行动计划:基于大健康理念的耐药控制宏图[J].中华临床感染病杂志,2016,9(4):289-293.
[24]Thiessen K,Lloyd AE,Miller MJ,et al.Assessing guidelineconcordant prescribing for community-acquired pneumonia[J].Int JClin Pharm,2017,39(4):674-678.
[25]May RC,Stone NR,Wiesner DL,et al.Cryptococcus:from environmental saprophyte to global pathogen[J].Nat Rev Microbiol,2016,14(2):106-117.