某“三甲”医院2013-2014年血液病患者抗真菌药物使用分析

Analysis of the Application of Antifungal Drugs in Haematologic Patients from a Third Grade Class A Hospital during 2013-2014

目的：为正确制订抗真菌治疗策略,促进抗真菌药物的规范使用提供参考。方法：回顾性调查某＂三甲＂医院2013年5月-2014年5月138例使用抗真菌药物的血液病患者,收集相关信息并进行统计分析。结果：138例患者中侵袭性真菌病确诊3例（均为念珠菌感染）,临床诊断6例,拟诊12例,未确定117例;真菌培养、真菌涂片镜检、（1,3）-β-D葡聚糖检测和半乳甘露聚糖检测的阳性率分别为15.3%、9.4%、6.4%和23.4%;共使用6种抗真菌药物,使用频率最高的为伏立康唑,其后依次为氟康唑、伊曲康唑、两性霉素B、卡泊芬净和米卡芬净;62.3%的患者单用1种抗真菌药物,15.9%的患者使用2种及以上抗真菌药物;平均用药疗程20.5 d（1~125 d）;不合理用药表现为药物选择不恰当、给药剂量不合理、更换抗真菌药物依据不足。结论：该院抗真菌药物的应用基本符合指南要求,但仍存在抗真菌药物治疗疗程不足等问题。

OBJECTIVE：To provide reference for the formulation of correct antifungal treatment strategy,and to promote standard use of antifungal agent. METHODS：A retrospective survey was conducted for 138 haematologic patients from May 2013 to May 2014 in a third grade class A hospital,of whom all had used antifungal drugs during hospitalization. We collected all patients＇ information and analyzed it statistically. RESULTS：Of 138 haematologic patients,3 were proven IFD（all were Candida infection）,6 were probable IFD,12 were possible IFD,and 117 were undefined IFD. The positive rates of fungi pathogenic detection,fungal smear,G-test,and GM-test were 15.3%,9.4%,6.4% and 23.4% respectively. 6 kinds of antifungal were used,and voriconazole had the highest frequency,followed by fluconazole,itraconazole,amphotericin B,caspofungin and micafungin. 62.3%patients used only one kind of antifungal,but 15.9% patients used 2 or more kinds of antifungal. The average medication course was 20.5 days（1 day to 125 days）. Irrational drug use showed improper drug selection,unreasonable dose,and replacing antifungal with insufficient basis. CONCLUSIONS：The antifungal use in haematologic patients in the hospital is consistent with the requirements of guidelines,but there are still some issues as insufficient antifurgal drug treatment course to be further standardized.