Analysis On Application Rationality Of Antifungal Agents For The Treatment Of Pulmonary Mycosis Patients In Pneumology Department

Objective: To investigate the rationality of antifungal agents for the treatment of pulmonary mycosis patients in pneumology department and the effective of antifungal therapy.Methods: Retrospective analysis the clinical data of 129 cases with pulmonary mycosis admitted to the first affiliated hospital of Guangxi Medical University from January 2015 to December 2015,analyzes the general situation,underlying diseases,high-risk factors,microbiological examination and pathogen constitute,the application of antifungal agents and outcome of treatment,and then the relevant data for statistical.Results:This study included 129 cases of pulmonary mycosis,of which 17 cases were proven diagnosis,36 cases were probable diagnosis and 76 possible diagnosis cases.The underlying diseases were reported in 117 cases(90.70%),mainly included chronic obstructive pulmonary disease(23.07%),pulmonary tuberculosis(21.37%),and bronchiectasia(16.24%).Use of broad-spectrum antibiotics for 14 days or more,invasive operation,radiotherapy andchemotherapy,continue to use the hormone and immune inhibitor,length of stay in intensive care unit are high-risk factors of pulmonary mycosis.In 129 cases of pulmonary mycosis,the detectable rate of the pathogenic bacteria was 93.02%,59 strains of fungus were detected,including 25 strains of candida(42.4%),24 strains of aspergillus(40.7%),7 strains of penicillium marneffei(10.2%),2strains of cryptococcus(3.4%)and 1 strain of unknown(3.4%).There were 118 patients treated by antifungal drugs,of which 101 cases were proved to be reasonable.According to the values of DDD analysis,the highest of defined daily doses was fluconazole,the highest of drug utilization index was voriconazole。To evaluated the treatment effect in patients 98 cases which use more than 7 days of anti-fungal agents,total effective rate was 77.78%,of which efficient of targeted therapy group,pre-emptive therapy group,efficient of empirical therapy group were 100%,77.78%,70.91%,the effective difference between three groups have no statistical significance(P>0.05).Monotherapy group effective rate was75.00%,combination therapy groupeffective rate was83.33%,the effective difference between two groups have no statistical significance(P>0.05).Conclusions:1.Pulmonary mycosis patients often combine with underlying diseases and high-risk factors.2.The most common pathogenic fungus of pulmonary mycosis were candida and aspergillus,sputum culture was the most common fungal etiological examination and histopathology examination of diagnosis significance were less.3.The main drug for antifungal therapy was triazole antifungal,in this study the most antifungal drugs is reasonable,but there are still unreasonable phenomenon,mainly displays in: ○1 the improper drug choice;○2 unloading doses;○3 unreasonable drug use frequency;○4 inadequatecourses of treatment;○5 improper combination therapy.4 To pulmonary mycosis,target therapy,pre-emptive therapy and empirical therapy had a certain effectiveness,and there still had clinical significance to conduct empirical therapies for patients at early stage.5.Monotherapy of pulmonary mycosis could achieve a high efficient,but we still need to conduct combination drug therapy in necessity.