呼吸内科酵母样真菌分离率与治疗用药之间量化关系的初步研究

Study on quantitive relationship between the clinical isolation rate of yeast and the influence of use of different drugs in wards of respiratory diseases

目的:了解临床药物的使用强度和酵母菌分离率之间的量化关系,提高抗感染治疗的效果。方法:监测2007年1月—2009年12月每季度我院呼吸内科病区酵母菌样真菌分离率,以及该病区抗菌药物和可能对患者免疫力造成负面影响的药物(包括抗肿瘤药物和糖皮质激素类药物)每季度消耗的数据,并将其换算成国际上相关研究所共同采用的使用强度指标:每100住院人天所消耗的DDD数量(DDD/100人天),然后进行相关分析。结果:2007—2009年各类感染的病原菌中酵母样真菌占首位,酵母样真菌分离率在2008年第一季度形成高峰,而后逐渐回落,始终在8%上下波动。在统计的药物中抗菌药物使用强度最高;单一品种抗菌药物使用强度最大的前三位为莫西沙星、头孢呋欣和头孢哌酮/舒巴坦。酵母样真菌分离率与抗菌药物中的头孢哌酮/舒巴坦钠、替考拉宁及抗结核药物中的利福平和吡嗪酰胺的使用量呈负相关(r=-0.600,-0.621,-0.405,-0.435,P<0.05),与抗肿瘤药物顺铂的使用量呈正相关(r=0.644,P<0.05)。结论:一些药物使用强度的变化可能对酵母样真菌分离率的影响较大,如果有针对性地调整这几类药物的使用强度有可能降低酵母样真菌的临床分离率。

Objective： To investigate the quantitative relationship between the pressure of drug administration and clinical isolation rate of common pathogenic bacteria. Methods： Data of consumption of different kinds of drugs including antibiotics and drugs that would exert effects on immune system were collected in each season from January 2007 to December 2009, and transformed these data to the antibiotic pressure index [-expressed as the number of defined daily doses （DDD） per 100 patients per day], meanwhile, clinical isolation rate of pathogenic yeast form fungi was also calculated. The correlation coefficient between pressure of drug administration and the isolation rate of yeast was calculated. Results： The isolation rate of pathogenic yeast form fungi was dominant among the detected pathogens between 2007 and 2009, and reached the peak at the first season in 2008, and then it gradually lowered, and fluctuated at the level of 8 %. The intensity of all drugs administered in our hospital was statistically calculated, among which antimicrobial agents were the most commonly used, and the first three most commonly used antimicrobial agents were moxifloxacin, Cefuroxime, and Cefoperazone/sulbactam. The correlation between isola- tion rate of pathogenic yeast form fungi and the dosage of the drugs used was also calculated , and a negative correlation was observed between antimicrobial agents as Cefoperazone/sulbactam and Teicoplannin and anti- tuberculosis drugs as Rifampicin and Pyrazinamide and positive isolation rate of fungi and a positive correlation was found between anti-neoplasms drugs as cisplatin, and the correlation coefficient was respectively - 0. 600, - 0. 621, - 0. 405,-0. 435, 0. 644（P〈0. 05）. Conclusions： The results suggest that the change in intensity of use of drugs such as Cefoperazone/sulbactam, Teicoplannin, Rifampiein, Pyrazinamide and Cisplatin in our hospital might exert positive effect on clinical isolation rate of pathogenic yeast form fungi, and an adjustment in the consumption of these antibiotic might decrease clinical isolation rate.