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。

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。

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。

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。

To analyze the infectious status of nosocomialCryptococcus neoformansin recent years and to explore the use of antibacterial drugs in patients with pulmonary cryptococcosis.

Data of patients withCryptococcus neoformansinfection in the First Affiliated Hospital of Nanjing Medical University enrolled from October 1st 2016 to September 30th 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.

Within 5 years, a total of 66 cases withCryptococcus neoformanswere 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 forCryptococcus neoformanscapsule 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) dvs. (10 ± 3)d] and the cost of antibacterial drug [(3 462.6 ± 2 277.1) yuanvs. (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.

In recent years, the infection site ofCryptococcus neoformansin 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 ofCryptococcus neoformansinfection.