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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 林淑文 | |
dc.contributor.author | Chih-Min Fu | en |
dc.contributor.author | 傅至敏 | zh_TW |
dc.date.accessioned | 2021-06-13T02:43:24Z | - |
dc.date.available | 2016-10-07 | |
dc.date.copyright | 2011-10-07 | |
dc.date.issued | 2011 | |
dc.date.submitted | 2011-07-29 | |
dc.identifier.citation | 1. Pfaller MA, Diekema DJ, Gibbs DL, et al. Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: a 10.5-year analysis of susceptibilities of Candida Species to fluconazole and voriconazole as determined by CLSI standardized disk diffusion. J Clin Microbiol 2010;48:1366-77.
2. Pappas Peter G, Kauffman Carol A, Andes D, et al. Clinical Practice Guidelines for the Management of Candidiasis: 2009 Update by the Infectious Diseases Society of America. Clin Microbiol Infect 2009;48:503-35. 3. Pappas P, Rex J, Sobel J, et al. Guidelines for treatment of candidiasis. Clin Microbiol Infect 2004;38:161-89. 4. Ruan SY, Huang YT, Chu CC, et al. Candida glabrata fungaemia in a tertiary centre in Taiwan: antifungal susceptibility and outcomes. International Journal of Antimicrobial Agents 2009;34:236-9. 5. Yang YL, Wang AH, Wang CW, et al. Susceptibilities to amphotericin B and fluconazole of Candida species in Taiwan Surveillance of Antimicrobial Resistance of Yeasts 2006. Diagn Microbiol Infect Dis 2008;61:175-80. 6. Malani A, Hmoud J, Chiu L, et al. Candida glabrata fungemia: experience in a tertiary care center. Clin Microbiol Infect 2005;41:975-81. 7. Ruan SY, Hsueh PR. Invasive candidiasis: an overview from Taiwan. Journal of the Formosan Medical Association 2009;108:443-51. 8. Yamamura DL, Rotstein C, Nicolle LE, et al. Candidemia at selected Canadian sites: results from the Fungal Disease Registry, 1992-1994. Fungal Disease Registry of the Canadian Infectious Disease Society. CMAJ 1999;160:493-9. 9. Wey SB, Mori M, Pfaller MA, et al. Hospital-acquired candidemia. The attributable mortality and excess length of stay. Arch Intern Med 1988;148:2642-5. 10. Pappas PG, Rex JH, Lee J, et al. A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients. Clin Infect Dis 2003;37:634-43. 11. Tsai C, Wang C, Kuo H, et al. Adult candidemia at a medical center in northern Taiwan: a retrospective study. J Microbiol Immunol Infect 2008;41:414-21. 12. Viudes A, Peman J, Canton E, et al. Candidemia at a tertiary-care hospital: epidemiology, treatment, clinical outcome and risk factors for death. Eur J Clin Microbiol Infect Dis 2002;21:767-74. 13. Macphail GL, Taylor GD, Buchanan-Chell M, et al. Epidemiology, treatment and outcome of candidemia: a five-year review at three Canadian hospitals. Mycoses 2002;45:141-5. 14. Blot S, Vandewoude K, Hoste E, Poelaert J, Colardyn F. Outcome in critically ill patients with candidal fungaemia: Candida albicans vs. Candida glabrata. J Hosp Infect 2001;47:308-13. 15. Ruan SY, Lee LN, Jerng JS, et al. Candida glabrata fungaemia in intensive care units. Clin Microbiol Infect 2008;14:136-40. 16. Fidel PL, Jr., Vazquez JA, Sobel JD. Candida glabrata: review of epidemiology, pathogenesis, and clinical disease with comparison to C. albicans. Clin Microbiol Rev 1999;12:80-96. 17. Wingard JR. Importance of Candida species other than C. albicans as pathogens in oncology patients. Clin Infect Dis 1995;20:115-25. 18. Yang YL, Li SY, Cheng HH, et al. Susceptibilities to amphotericin B and fluconazole of Candida species in TSARY 2002. Diagn Microbiol Infect Dis 2005;51:179-83. 19. Bodey GP, Mardani M, Hanna HA, et al. The epidemiology of Candida glabrata and Candida albicans fungemia in immunocompromised patients with cancer. Am J Med 2002;112:380-5. 20. Komshian SV, Uwaydah AK, Sobel JD, et al. Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics, and evaluation of factors influencing outcome. Rev Infect Dis 1989;11:379-90. 21. Bodey GP. Candidiasis in cancer patients. Am J Med 1984;77:13-9. 22. Pfaller MA, Diekema DJ, Gibbs DL, et al. Geographic variation in the frequency of isolation and fluconazole and voriconazole susceptibilities of Candida glabrata: an assessment from the ARTEMIS DISK Global Antifungal Surveillance Program. Diagn Microbiol Infect Dis 2010;67:162-71. 23. Pfaller MA, Diekema DJ. Twelve years of fluconazole in clinical practice: global trends in species distribution and fluconazole susceptibility of bloodstream isolates of Candida. Clin Microbiol Infect 2004;10 Suppl 1:11-23. 24. Lyon GM, Karatela S, Sunay S, et al. Antifungal susceptibility testing of Candida isolates from the Candida surveillance study. J Clin Microbiol 2010;48:1270-5. 25. Garey K, Pai M, Suda K, et al. Inadequacy of fluconazole dosing in patients with candidemia based on Infectious Diseases Society of America (IDSA) guidelines. Pharmacoepidemiology and Drug Safety 2007;16:919-27. 26. Tumbarello M, Sanguinetti M, Trecarichi E, et al. Fungaemia caused by Candida glabrata with reduced susceptibility to fluconazole due to altered gene expression: risk factors, antifungal treatment and outcome. Journal of antimicrobial chemotherapy 2008. 27. Ruan SY, Chu CC, Hsueh PR. In vitro susceptibilities of invasive isolates of Candida species: rapid increase in rates of fluconazole susceptible-dose dependent Candida glabrata isolates. Antimicrob Agents Chemother 2008;52:2919-22. 28. Rex JH, Walsh TJ, Sobel JD, et al. Practice guidelines for the treatment of candidiasis. Infectious Diseases Society of America. Clin Infect Dis 2000;30:662-78. 29. Rex J, Pfaller M, Galgiani J, et al. Development of interpretive breakpoints for antifungal susceptibility testing: conceptual framework and analysis of in vitro-in vivo correlation data for fluconazole, itraconazole, and Candida infections. Clin Infect Dis 1997;24:235-47. 30. Pfaller MA, Diekema DJ, Sheehan DJ. Interpretive Breakpoints for Fluconazole and Candida Revisited: a Blueprint for the Future of Antifungal Susceptibility Testing. Clinical Microbiology Reviews 2006;19:435-47. 31. Rex JH, Pfaller MA, Walsh TJ, et al. Antifungal Susceptibility Testing: Practical Aspects and Current Challenges. Clinical Microbiology Reviews 2001;14:643-58. 32. Andes D. In Vivo Pharmacodynamics of Antifungal Drugs in Treatment of Candidiasis. Antimicrob Agents Chemother 2003;47:1179-86. 33. Baddley JW, Patel M, Bhavnani SM, et al. Association of Fluconazole Pharmacodynamics with Mortality in Patients with Candidemia. Antimicrob Agents Chemother 2008;52:3022-8. 34. Pai MP, Turpin RS, Garey KW. Association of Fluconazole Area under the Concentration-Time Curve/MIC and Dose/MIC Ratios with Mortality in Nonneutropenic Patients with Candidemia. Antimicrob Agents Chemother 2006;51:35-9. 35. Pfaller MA, Andes D, Diekema DJ,et al. Wild-type MIC distributions, epidemiological cutoff values and species-specific clinical breakpoints for fluconazole and Candida: Time for harmonization of CLSI and EUCAST broth microdilution methods. Drug Resistance Updates 2010;13:180-95. 36. Clancy CJ, Yu VL, Morris AJ, et al. Fluconazole MIC and the Fluconazole Dose/MIC Ratio Correlate with Therapeutic Response among Patients with Candidemia. Antimicrob Agents Chemother 2005;49:3171-7. 37. Rodriguez-Tudela JL, Almirante B, Rodriguez-Pardo D, et al. Correlation of the MIC and Dose/MIC Ratio of Fluconazole to the Therapeutic Response of Patients with Mucosal Candidiasis and Candidemia. Antimicrob Agents Chemother 2007;51:3599-604. 38. Cuesta I, Bielza C, Larranaga P, et al. Data Mining Validation of Fluconazole Breakpoints Established by the European Committee on Antimicrobial Susceptibility Testing. Antimicrob Agents Chemother 2009;53:2949-54. 39. CLSI. Reference method for broth dilution anyifungal susceptibility testing of yeasts; approved standard-third edition. CLSI document M27-A3. Wayne, PA: Clinical and Laboratory Standards Institute; 2008. 40. Wilson A, Micek S, Ritchie D. A retrospective evaluation of fluconazole for the treatment of Candida glabrata fungemia. Clinical therapeutics 2005;27:1228-37. 41. Hospenthal D, Murray C, Rinaldi M. The role of antifungal susceptibility testing in the therapy of candidiasis. Diagn Microbiol Infect Dis 2004;48:153. 42. Cuesta I, Bielza C, Cuenca-Estrella M, et al. Evaluation by Data Mining Techniques of Fluconazole Breakpoints Established by the Clinical and Laboratory Standards Institute (CLSI) and Comparison with Those of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Antimicrob Agents Chemother 2010;54:1541-6. 43. Cheng Y, Lin L, Young T, et al. Risk factors for candidemia-related mortality at a medical center in central Taiwan. Journal of Microbiology Immunology and Infection 2006;39:155. 44. Fraser V, Jones M, Dunkel J, et al. Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality. Clin Infect Dis 1992;15:414-21. 45. Hung CC, Chen Y.C., Chang S.C., et al. Nosocomial candidemia in a university hospital in Taiwan. J Formos Med Assoc 1996;95:19-28. 46. Blumberg HM, Jarvis WR, Soucie JM, et al. Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey. Clin Infect Dis 2001;33:177-86. 47. Luzzati R, Amalfitano G, Lazzarini L, et al. Nosocomial candidemia in non-neutropenic patients at an Italian tertiary care hospital. Eur J Clin Microbiol Infect Dis 2000;19:602-7. 48. Nguyen MH, Peacock JE, Jr., Tanner DC, et al. Therapeutic approaches in patients with candidemia. Evaluation in a multicenter, prospective, observational study. Arch Intern Med 1995;155:2429-35. 49. Nucci M, Silveira MI, Spector N, et al. Risk factors for death among cancer patients with fungemia. Clin Infect Dis 1998;27:107-11. 50. Hsu FC, Lin PC, Chi CY, et al. Prognostic factors for patients with culture-positive Candida infection undergoing abdominal surgery. J Microbiol Immunol Infect 2009;42:378-84. 51. Peres-Bota D, Rodriguez-Villalobos H, Dimopoulos G, et al. Potential risk factors for infection with Candida spp. in critically ill patients. Clin Microbiol Infect 2004;10:550-5. 52. Alonso-Valle H, Acha O, Garcia-Palomo J, et al. Candidemia in a tertiary care hospital: epidemiology and factors influencing mortality. European Journal of Clinical Microbiology & Infectious Diseases 2003;22:254-7. 53. Velasco E, Bigni R. A prospective cohort study evaluating the prognostic impact of clinical characteristics and comorbid conditions of hospitalized adult and pediatric cancer patients with candidemia. Eur J Clin Microbiol Infect Dis 2008;27:1071-8. 54. Chen LY, Liao SY, Kuo SC, et al. Changes in the incidence of candidaemia during 2000-2008 in a tertiary medical centre in northern Taiwan. J Hosp Infect 2011;78:50-3. 55. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83. 56. Segal BH, Herbrecht R, Stevens DA, et al. Defining responses to therapy and study outcomes in clinical trials of invasive fungal diseases: Mycoses Study Group and European Organization for Research and Treatment of Cancer consensus criteria. Clin Infect Dis 2008;47:674-83. 57. National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 Published: May 28, 2009 (v4.03: June 14, 2010) 58. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239-45. 59. Valles J, Calbo E, Anoro E, et al. Bloodstream infections in adults: importance of healthcare-associated infections. J Infect 2008;56:27-34. 60. Kung HC, Wang JL, Chang SC, et al. Community-onset candidemia at a university hospital, 1995-2005. J Microbiol Immunol Infect 2007;40:355-63. 61. Madhavan P, Jamal F, Chong PP, Ng KP. In vitro activity of fluconazole and voriconazole against clinical isolates of Candida spp. by E-test method. Trop Biomed 2010;27:200-7. 62. Chen YC, Chang SC, Luh KT, Hsieh WC. Stable susceptibility of Candida blood isolates to fluconazole despite increasing use during the past 10 years. J Antimicrob Chemother 2003;52:71-7. 63. Liebowitz LD, Ashbee HR, Evans EG, et al. A two year global evaluation of the susceptibility of Candida species to fluconazole by disk diffusion. Diagn Microbiol Infect Dis 2001;40:27-33. 64. Viscoli C GC, Marinus A, et al. Candidemia in cancer patients: a prospective, multicenter surveillance study by the Invasive Fungal Infection Group (IFIG) of the European Organization for Research and Treatment of Cancer (EORTC). Clin Infect Dis 1999;28:1071-9. 65. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31:1250-6. 66. Robertson CM, Coopersmith CM. The systemic inflammatory response syndrome. Microbes Infect 2006;8:1382-9. 67. Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006;34:344-53. 68. Gumbo T, Isada CM, Hall G, et al. Candida glabrata Fungemia. Clinical features of 139 patients. Medicine (Baltimore) 1999;78:220-7. 69. Pittet D, Li N, Woolson RF, Wenzel RP. Microbiological factors influencing the outcome of nosocomial bloodstream infections: a 6-year validated, population-based model. Clin Infect Dis 1997;24:1068-78. 70. Kiraz N, Dag I, Oz Y, et al. Correlation between broth microdilution and disk diffusion methods for antifungal susceptibility testing of caspofungin, voriconazole, amphotericin B, itraconazole and fluconazole against Candida glabrata. Journal of Microbiological Methods 2010;82:136-40. 71. Metin DY, Hilmioglu-Polat S, Samlioglu P, et al. Evaluation of Antifungal Susceptibility Testing with Microdilution and Etest Methods of Candida Blood Isolates. Mycopathologia 2011. 72. Alexander BD, Byrne TC, Smith KL, et al. Comparative Evaluation of Etest and Sensititre YeastOne Panels against the Clinical and Laboratory Standards Institute M27-A2 Reference Broth Microdilution Method for Testing Candida Susceptibility to Seven Antifungal Agents. Journal of Clinical Microbiology 2007;45:698-706. 73. Sandven P. Detection of fluconazole-resistant Candida strains by a disc diffusion screening test. J Clin Microbiol 1999;37:3856-9. 74. Chen YC, Chang SC, Hsieh WC, Luh KT. In vitro antifungal susceptibilities of Candida species isolated from the blood. Int J Antimicrob Agents 1996;7:217-22. 75. Andes D, van Ogtrop M. Characterization and quantitation of the pharmacodynamics of fluconazole in a neutropenic murine disseminated candidiasis infection model. Antimicrob Agents Chemother 1999;43:2116-20. 76. Davis SL, Vazquez JA, McKinnon PS. Epidemiology, risk factors, and outcomes of Candida albicans versus non-albicans candidemia in nonneutropenic patients. Ann Pharmacother 2007;41:568-73. 77. Golan Y, Wolf MP, Pauker SG, et al. Empirical anti-Candida therapy among selected patients in the intensive care unit: a cost-effectiveness analysis. Ann Intern Med 2005;143:857-69. 78. Chen H, Suda KJ, Turpin RS, et al. High- versus low-dose fluconazole therapy for empiric treatment of suspected invasive candidiasis among high-risk patients in the intensive care unit: a cost-effectiveness analysis. Curr Med Res Opin 2007;23:1057-65. 79. Wingard JR, Wood CA, Sullivan E, et al. Caspofungin versus amphotericin B for candidemia: a pharmacoeconomic analysis. Clin Ther 2005;27:960-9. 80. Zilberberg MD, Kothari S, Shorr AF. Cost-effectiveness of micafungin as an alternative to fluconazole empiric treatment of suspected ICU-acquired candidemia among patients with sepsis: a model simulation. Crit Care 2009;13:R94. 81. Neoh CF, Liew D, Slavin M, et al. Cost-effectiveness analysis of anidulafungin versus fluconazole for the treatment of invasive candidiasis. J Antimicrob Chemother 2011. 82. Voss A, de Pauw BE. High-dose fluconazole therapy in patients with severe fungal infections. Eur J Clin Microbiol Infect Dis 1999;18:165-74. 83. Fluconazole. (n.d.). DrugPoints® System.Retrieved June 8, 2011, from http://www.thomsonhc.com. Greenwood Village, CO : Thomson Reuters (Healthcare) Inc. In. 84. Marion, DW. Fluconazole:drug information. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011 85. Marion, DW. Amphotericin B(conventional):drug information. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011. 86. Wang JL, Chang CH, Young-Xu Y, Chan KA. Systematic Review and Meta-Analysis of the Tolerability and Hepatotoxicity of Antifungals in Empirical and Definitive Therapy for Invasive Fungal Infection. Antimicrobial Agents and Chemotherapy 2010;54:2409-19. 87. Amphotericin B. (n.d.). DrugPoints® System.Retrieved June 8, 2011, from http://www.thomsonhc.com. Greenwood Village, CO : Thomson Reuters (Healthcare) Inc. 88. Noel GJ. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. J Pediatr 1999;135:399. 89. Amphotericin B liposome. (n.d.). DrugPoints® System.Retrieved June 8, 2011, from http://www.thomsonhc.com. Greenwood Village, CO : Thomson Reuters (Healthcare) Inc. 90. Prod Info AMBISOME(R) IV injection, 2008 US Food and Drug Administration. 91. Marion, DW. liposomal amphotericin B:drug information. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011. 92. Caspofungin. (n.d.). DrugPoints® System.Retrieved June 8, 2011, from http://www.thomsonhc.com. Greenwood Village, CO : Thomson Reuters (Healthcare) Inc. 93. Marion, DW. Caspofungin:drug information. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011 '. 94. Micafungin. (n.d.). DrugPoints® System.Retrieved June 8, 2011, from http://www.thomsonhc.com. Greenwood Village, CO : Thomson Reuters (Healthcare) Inc. 95. Marion, DW. Micafungin:drug information. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011. 96. Rex JH, Pappas PG, Karchmer AW, et al. A randomized and blinded multicenter trial of high-dose fluconazole plus placebo versus fluconazole plus amphotericin B as therapy for candidemia and its consequences in nonneutropenic subjects. Clin Infect Dis 2003;36:1221-8. 97. Torres HA, Kontoyiannis DP, Rolston KVI. High-dose fluconazole therapy for cancer patients with solid tumors and candidemia: an observational, noncomparative retrospective study. Supportive Care in Cancer 2004;12. 98. Rex JH, Bennett JE, Sugar AM, et al. Intravascular catheter exchange and duration of candidemia. NIAID Mycoses Study Group and the Candidemia Study Group. Clin Infect Dis 1995;21:994-6. 99. Goodrich JM, Reed EC, Mori M, et al. Clinical features and analysis of risk factors for invasive candidal infection after marrow transplantation. J Infect Dis 1991;164:731-40. 100. Moen MD, Lyseng-Williamson KA, Scott LJ. Liposomal amphotericin B: a review of its use as empirical therapy in febrile neutropenia and in the treatment of invasive fungal infections. Drugs 2009;69:361-92. 101. Lin MT, Lu HC, Chen WL. Improving efficacy of antifungal therapy by polymerase chain reaction-based strategy among febrile patients with neutropenia and cancer. Clin Infect Dis 2001;33:1621-7. 102. Rentz AM, Halpern MT, Bowden R. The impact of candidemia on length of hospital stay, outcome, and overall cost of illness. Clin Infect Dis 1998;27:781-8. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/31329 | - |
dc.description.abstract | 背景:
Fluconazole是治療念珠菌菌血症的首選藥物之一,目前雖然大部分的念珠菌菌種對於fluconazole都有感受性(susceptible,定義為最小抑菌濃度(MIC)≦ 8 mg/L)。但是,對於fluconazole有抗藥性(resistant,定義為MIC ≧ 64 mg/L)或呈現劑量依賴型感受性(susceptible-dose dependent,S-DD,定義為MIC = 16 ~ 32 mg/L)的菌種比例愈來愈高,尤其是Candida glabrata。許多文獻認為若維持fluconazole的每日劑量除以最小抑菌濃度之比值大於至少25-50,即能夠有效治療念珠菌感染,只是目前的研究多侷限在對fluconazole感受性較好的菌株或是念珠菌黏膜感染,所以是否能使用fluconazole治療C. glabrata菌血症仍然有許多爭議。 研究目的: 比較以不同劑量之fluconazole與其他抗黴菌藥品治療C. glabrata菌血症的臨床效果,並評估fluconazole劑量與相對應之C. glabrata 最小抑菌濃度的比值和C. glabrata菌血症治療效果之間的相關性,尤其當菌株的最小抑菌濃度為16~32 mg/L時的治療效果。 研究設計: 本研究納入2002年6月1日至2003年12月31日和2009年6月1日至2010年12月31日期間於臺大醫院治療C. glabrata菌血症的病人,以病歷回顧的方式收集病人基本資料、合併症、可能影響預後的潛在因子、C. glabrata菌血症發作前所使用的抗生素或抗黴菌藥物使用情形、相關的血液培養和對抗黴菌藥物的感受性結果、臨床表徵、所使用的抗黴菌藥物、相關檢驗數值和治療結果。 利用SAS統計套裝軟體(9.2版)整理資料及統計分析。統計方法包含卡方檢定、費雪精確檢定、t-test和Mann-Whitney U test。存活曲線由Kaplan-Meier method繪製並以Log-rank test比較差異。死亡危險因子分析則使用單變項分析與多變項邏吉斯逐步迴歸分析。 研究結果: 本研究共納入104位感染C. glabrata菌血症的病人,全體病人的年齡中位數為68歲,男女比例約為55:45,大部分的病人為院內感染。合併症方面,Charlson’s comorbidity score中位數為5分,癌症是所佔比例最高的合併症(64.4 %),其次為心血管疾病(58.7 %),腸胃道疾病、糖尿病和腎臟疾病也佔有一定的比例。另外,有30.7 %的病人免疫功能低下,發作前72小時內有使用呼吸器、導尿管或接受靜脈營養的比例分別為31.7 %、37.5 %和55.8 %。發作時身上有中央靜脈導管的比例高達九成,大部分的病人在發作前30天內也幾乎都有接受抗生素之治療,發作時Pitt bacteremia score中位數是2分,APACHE II score中位數為19.5分。 有一半(51.0 %)的病人未接受經驗性的抗黴菌藥物治療,有使用經驗性治療的病人則大多使用fluconazole(45.2 %),依照校正為正常腎功能的維持劑量以400 mg/day為主;確切治療的藥物選擇上,使用fluconazole、amphotericin B和echinocandin類藥物的比例分別為41.4 %、24.0 %和16.3 %,有18.3 %的病人未接受確切治療,使用fluconazole的病人中,51.2 %的病人維持劑量≦400 mg/day。全體病人在發作後第28天的死亡率為52.9 %,達到成功治療效果的比例則為45.2 %。經驗性治療選擇何種藥物或沒有用藥的病人之預後並無顯著差異:確切治療若使用fluconazole則治療效果較差:fluconazole、amphotericin B和echinocandin類藥物在發作後第28天達到成功治療的比例分別為39.5 %、64.0 %和70.6 %(p=0.04)。針對確切治療使用fluconazole的病人,每日劑量>400 mg的死亡率較使用≦400 mg的低(38.1 % vs. 72.7 %),而且達到成功治療效果的比例較高(61.9 % vs. 27.3 %),達到統計上的顯著差異,p值皆為0.03。當fluconazole每日劑量除以最小抑菌濃度的比值>25或50時,觀察到死亡率較低且治療效果較好的趨勢,即使針對最小抑菌濃度較高(16~32 mg/L)的C. glabrata菌株,治療效果和amphotericin B和echinocandin類藥物比較亦未有顯著差異。 以單變項分析評估影響發作後第28天死亡率的危險因子,包含Charlson’s comorbidity score較高(p=0.04)、有使用呼吸器(p=0.02)、導尿管(p=0.01)、接受靜脈營養輸注(p=0.03)、未移除或更換中央靜脈導管(p=0.02)、有敗血性休克的臨床表徵(p=0.04)及較高的Pitt bacteremia score和APACHE II score(p<0.05),住院天數(尤其是發作後住院天數)和死亡率成反比關係。而APACHE II score ≧23(OR:7.78,p=0.0032)、在C. glabrata菌血症發作前72小時有使用導尿管(OR:1.52,p=0.0295)和接受靜脈營養輸注(OR:3.79,p=0.0473)是影響C. glabrata菌血症發作後第28天內死亡之獨立危險因子。 結論: 若欲使用fluconazole治療C. glabrata菌血症,建議使用>400 mg/day的維持劑量(校正為正常腎功能後的劑量),且應監測最小抑菌濃度。對於最小抑菌濃度≦32 mg/L的菌株,使用fluconazole的治療效果似乎不遜於其他抗黴菌藥物,但應維持每日劑量除以最小抑菌濃度之比值至少>25。而C. glabrata菌血症發作當時的疾病嚴重程度、是否使用導尿管和接受靜脈營養輸注會顯著影響C. glabrata菌血症發作後第28天的死亡率。 | zh_TW |
dc.description.provenance | Made available in DSpace on 2021-06-13T02:43:24Z (GMT). No. of bitstreams: 1 ntu-100-R98451002-1.pdf: 763871 bytes, checksum: a82816946888104ca61b4c23365c9569 (MD5) Previous issue date: 2011 | en |
dc.description.tableofcontents | 第一章 緒論 1
第二章 文獻探討 2 第1節 念珠菌菌血症 2 2.1.1 簡介 2 2.1.2 Candida glabrata 2 2.1.3 Candida glabrata對fluconazole的感受性 5 第2節 Candida glabrata菌血症之治療 7 2.2.1 抗黴菌藥物的選擇 7 2.2.2 Fluconazole的每日劑量除以最小抑菌濃度之比值 7 第3節 Candida glabrata菌血症之死亡危險因子 11 第三章 研究目的 14 第四章 研究方法 15 第1節 研究架構 15 第2節 研究地點及研究對象 15 4.2.1 納入條件 15 4.2.2 排除條件 16 第3節 資料收集 16 4.3.1 病人基本資料 16 4.3.2 合併症及影響預後之潛在因子 16 4.3.3 C. glabrata菌血症發作前之感染 17 4.3.4 C. glabrata菌血症發作時之資料收集 17 4.3.5 抗黴菌藥物之治療 18 4.3.6 後續黴菌或細菌之培養結果 19 4.3.7 治療反應、結果與不良反應 19 第4節 名詞定義 21 4.4.1 院內感染 21 4.4.2 醫療照護相關感染 21 4.4.3 社區感染 21 4.4.4 免疫功能低下 22 4.4.5 最小抑菌濃度檢測方法 22 4.4.6 持續的C. glabrata菌血症 23 4.4.7 多重菌種感染 23 4.4.8 臨床表現 23 第5節 統計分析方法 24 第五章 研究結果 25 第1節 描述性統計 25 5.1.1 收案過程與病人數 25 5.1.2 病人基本資料 26 5.1.3 病人合併症 27 5.1.4 影響預後之潛在因子 28 5.1.5 先前使用抗生素之情形 30 5.1.6 C. glabrata菌血症發作時之疾病嚴重程度 31 5.1.7 多重菌種感染的菌種分布情形 31 5.1.8 抗黴菌藥物之處方情形 32 第2節 死亡率及預後分析 34 5.2.1 單純C. glabrata菌血症感染與多重菌種感染的比較 34 5.2.2 抗黴菌藥物種類與死亡率及預後之比較 35 5.2.3 Fluconazole使用劑量與死亡率及預後之比較 38 5.2.4 高劑量fluconazole與其他抗黴菌藥物之比較 41 5.2.5 Fluconazole劑量除以最小抑菌濃度之比值 42 5.2.5.1 最小抑菌濃度之分析 42 5.2.5.2 劑量除以最小抑菌濃度之比值對死亡率和預後的影響 43 5.2.5.3 Fluconazole與其他抗黴菌藥物之比較 46 第3節 死亡危險因子之單變項統計分析 48 5.3.1 單純C. glabrata菌血症感染 48 5.3.2 多重菌種感染 48 第4節 死亡危險因子之多變項統計分析 56 第5節 藥物不良反應評估 57 5.5.1 肝指數異常相關性評估 57 5.5.2 腎毒性相關性評估 58 第六章 討論 59 第1節 感染C. glabrata菌血症之病人族群 59 6.1.1 整體病人族群 59 6.1.2 單純C. glabrata菌血症感染與多重菌種感染 60 6.1.3 2002-2003年與2009-2010年 60 6.1.4 接受抗黴菌藥物的天數是否小於5天 61 第2節 最小抑菌濃度 63 6.2.1 最小抑菌濃度檢驗方法的差別 63 6.2.2 最小抑菌濃度的演變 65 第3節 抗黴菌藥物治療 67 6.3.1 2002-2003年與2009-2010年的處方型態差別 67 6.3.2 依照腎功能校正的fluconazole劑量 68 6.3.3 經驗性治療 69 6.3.4 抗黴菌藥品的選擇與最小抑菌濃度的關係 70 6.3.5 劑量除以最小抑菌濃度的關係 71 6.3.6 藥物經濟學的觀點 72 6.3.7 藥物不良反應評估 73 第4節 影響預後之危險因子分析 75 6.4.1 未移除或更換中央靜脈導管 76 6.4.2 血液培養陽性結果的持續天數 76 第5節 研究限制 77 6.5.1 研究地點及病人族群 77 6.5.2 資料收集及研究偏差 77 第七章 結論 79 第八章 參考資料 80 | |
dc.language.iso | zh-TW | |
dc.title | 某醫學中心使用Fluconazole與其他抗黴菌藥品治療Candida glabrata菌血症之療效分析 | zh_TW |
dc.title | Fluconazole for Candida glabrata fungemia: outcomes and comparison to other antifungal agents in a medical center | en |
dc.type | Thesis | |
dc.date.schoolyear | 99-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 沈麗娟 | |
dc.contributor.oralexamcommittee | 陳宜君,蕭斐元,張上淳 | |
dc.subject.keyword | C. glabrata,念珠菌菌血症,fluconazole,劑量與最小抑菌濃度之比值, | zh_TW |
dc.subject.keyword | C. glabrata,candidemia,fluconazole,daily dose/MIC, | en |
dc.relation.page | 85 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2011-08-01 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床藥學研究所 | zh_TW |
顯示於系所單位: | 臨床藥學研究所 |
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