Infectious status and antibacterial agents using of Cryptococcus Neoformans infection

doi:10.3877/cma.j.issn.1674-1358.2018.04.012

Abstract

Abstract:

Objective

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

Methods

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.

Results

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.

Conclusions

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.

Key words: Cryptococcus neoformans, Antibacterial agents, Cryptococcal antigen, Bacterial pneumonia

Xiaolin Ge, Siyuan Tan, Yongxiang Zhang, Weihong Zhang, Bo Liu. Infectious status and antibacterial agents using of Cryptococcus Neoformans infection[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(04): 376-380.

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References 25

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项目		例（%）
性别		?
?	男	41（62.12）
?	女	25（37.88）
感染部位		?
?	肺部	48（72.73）
?	中枢神经系统	16（24.25）
?	皮肤	1（1.51）
?	全身播散性	1（1.51）
科室分布		?
?	呼吸与危重症医学科	42（63.64）
?	感染病科	9（13.64）
?	神经内科	3（4.54）
?	风湿免疫科	2（3.03）
?	普通内科	2（3.03）
?	其他	8（12.12）

项目		例（%）
性别		?
?	男	41（62.12）
?	女	25（37.88）
感染部位		?
?	肺部	48（72.73）
?	中枢神经系统	16（24.25）
?	皮肤	1（1.51）
?	全身播散性	1（1.51）
科室分布		?
?	呼吸与危重症医学科	42（63.64）
?	感染病科	9（13.64）
?	神经内科	3（4.54）
?	风湿免疫科	2（3.03）
?	普通内科	2（3.03）
?	其他	8（12.12）

基础疾病类型	例（%）
糖尿病	11（35.48）
AIDS	3（9.67）
肾移植术后	2（6.45）
系统性红斑狼疮	2（6.45）
恶性肿瘤	2（6.45）
狼疮性肾炎	1（3.23）
IgA肾病	1（3.23）
强直性脊柱炎	1（3.23）
肺结核病	1（3.23）
类风湿性关节炎	1（3.23）
肝硬化	1（3.23）
其他使用免疫抑制剂者	5（16.12）

基础疾病类型	例（%）
糖尿病	11（35.48）
AIDS	3（9.67）
肾移植术后	2（6.45）
系统性红斑狼疮	2（6.45）
恶性肿瘤	2（6.45）
狼疮性肾炎	1（3.23）
IgA肾病	1（3.23）
强直性脊柱炎	1（3.23）
肺结核病	1（3.23）
类风湿性关节炎	1（3.23）
肝硬化	1（3.23）
其他使用免疫抑制剂者	5（16.12）

组别	例数	抗菌药物使用天数（±s，d）	住院总天数（±s，d）	抗菌药物使用费用（±s，元）	住院总费用（元）^a
肺隐球菌病	11	11 ± 5	18 ± 8	3 462.6 ± 2 277.1	17 107.6（9 041.8，27 642.2）
细菌性肺炎	11	10 ± 3	10 ± 3	4044.7 ± 1898.9	8 731.9（6076.0，14124.5）
统计量	?	t = 0.745	t = 3.145	Z =－0.968	Z =－2.803
P值	?	0.475	0.012	0.333	0.005

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