2011年1月-2013年1月某院侵袭性肺部真菌感染患者的抗真菌药物应用分析  

Analysis on the Use of Antifungal Agents in the Patients with Invasive Pulmonary Fungal Infections in a Hospital during Jan.2011-Jan.2013

作　　者：王淼[1] 杜瑜[1] 尹小文[1] 

机构地区：[1]厦门大学附属中山医院,福建厦门361004

出　　处：《中国药房》2013年第42期3952-3955,共4页China Pharmacy

摘　　要：目的:为临床规范用药提供有益参考。方法:采用回顾性分析方法,分析2011年1月-2013年1月某院侵袭性肺部真菌感染患者住院期间抗真菌药物使用情况,参照中国《侵袭性肺部真菌感染的诊断标准与治疗原则(草案)》、《血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(第三次修订)》、美国感染性疾病协会(IDSA)于2008年及2009年发布的《真菌病治疗指南》,评价其应用的合理性。结果:68例肺部真菌感染患者中,确诊5例,临床诊断43例,拟诊20例;病原菌以白色念珠菌为主,占53.52%;抗真菌治疗平均疗程为(17.57±12.90)d;共使用氟康唑、伏立康唑、两性霉素B、卡泊芬净、米卡芬净、伊曲康唑6种抗真菌药物,DDDs排名前3位的是氟康唑、伏立康唑和两性霉素B,DUI值大于1的有氟康唑、伊曲康唑。结论:该院侵袭性肺部真菌感染患者的抗真菌治疗方案基本符合中国指南要求,体现了个体化原则,但仍存在药物品种选择不当、更换证据不足、超剂量使用、疗程把握不准确等问题,有待进一步规范。OBJECTIVE： To provide some useful references for normative clinical medication. METHODS ： The use of antifun- gal agents in the patients with invasive pulmonary fungal infection was analyzed retrospectively during Jan. 2011--Jan. 2013. The rationality of it was evaluated according to Diagnosis Standard and Treatment Principles of lnvasive Pulmonary Fungal Infection （Draft）, Diagnosis Standard and Treatment Principles for Hematologic^Malignant Tumor Patients with lnvasive Pulmonary Fungal Infection （Third Edition） from China and Guidelines for the Treatment of Fungal Disease from IDSA in 2008 and 2009. RE- SULTS： Among 68 cases of invasive pulmonary fungal infection, 5 of them were definitely diagnosed, 43 were clinically diag- nosed and 20 were suspected. The predominant antigen was Candida albicans, accounting for 53.52% ; the mean therapy course was （17.57 ＋ 12.90.） days; 6 kinds of antifungal agents were used, including fluconazole, voriconazole, amphotericin B, caspofun- gin, micafungin and itraconazole; top 3 antifungal agents in the list of DDDs were fluconazole, voriconazole and amphotericin B; DU1 of fluconazole and itraconazole were more than 1 among those agents. CONCLUSIONS ： The use of antifungal agent in the pa- tient with invasive pulmonary fungal infection is almost consistent with the guideline of China, reflecting individualized principium. But the problems involving inappropriate choice of drugs, drug replacement with insufficient evidence, overdose and inaccurate course of treatment still exist, which need to be further standardized.

关 键 词：侵袭性肺部真菌感染 抗真菌药物 合理用药 

分 类 号：R978.5[医药卫生—药品] R969.3[医药卫生—药学]