Laverdière M, Rotstein C, Bow E J, Roberts R S, Ioannou S, Carr D, Moghaddam N
Department of Microbiology and Infectious Diseases, Hôpital Maisonneuve-Rosemont, 5415 Boulevard l'Assomption, Montréal, Québec, Canada H1T 2M4.
J Antimicrob Chemother. 2000 Dec;46(6):1001-8. doi: 10.1093/jac/46.6.1001.
Fungal colonization profiles from four different anatomical sites were evaluated in 266 neutropenic cancer patients receiving intensive cytotoxic therapy for acute leukaemia or for autologous marrow transplantation. At the beginning of chemotherapy patients were allocated randomly to receive oral fluconazole 400 mg daily or an identical placebo until prophylaxis failure or marrow recovery. Candida albicans colonization was reduced from 30 to 10% in the fluconazole recipients while it increased from 32 to 57% in the placebo patients (P<0.001). By the end of prophylaxis, colonization with non-albicans Candida species increased from 7 to 21% and 8 to 18% in the fluconazole and placebo patients, respectively (P = 0.396). Although Candida glabrata was isolated more frequently at the end of the prophylactic period in the fluconazole patients than in the placebo patients (16 versus 7%), only one definite invasive C. glabrata infection was noted. Overall, definite invasive fungal infections were documented in 26 patients [four fluconazole versus 22 placebo patients (P< or =0.001)]. In 23 (92%) patients the infections were caused by persistently colonizing or newly acquired organisms. While probable invasive fungal infections were noted in five fluconazole patients, 10 placebo patients were also affected (P = 0.19). An end-of-prophylaxis colonization index >0.25 was 76% sensitive but only 69% specific for invasive fungal infection. However, a colonization index < or =0.25 at baseline had a negative predictive value of 88% for development of invasive fungal infection. Fluconazole prophylaxis decreased colonization by fungi and subsequent invasive fungal infections in neutropenic cancer patients.
对266例接受急性白血病强化细胞毒性治疗或自体骨髓移植的中性粒细胞减少的癌症患者，评估了来自四个不同解剖部位的真菌定植情况。化疗开始时，患者被随机分配接受每日400mg口服氟康唑或相同的安慰剂，直至预防失败或骨髓恢复。氟康唑治疗组白色念珠菌定植率从30%降至10%，而安慰剂组从32%升至57%（P<0.001）。预防结束时，氟康唑组和安慰剂组非白色念珠菌属真菌的定植率分别从7%升至21%和从8%升至18%（P = 0.396）。虽然在预防期结束时，氟康唑组光滑念珠菌的分离率高于安慰剂组（16%对7%），但仅记录到1例明确的光滑念珠菌侵袭性感染。总体而言，则有26例患者记录到明确的侵袭性真菌感染[氟康唑组4例对安慰剂组22例（P≤0.001）]。23例（92%）患者的感染由持续定植或新获得的病原体引起。虽然在5例氟康唑患者中发现了可能的侵袭性真菌感染，但10例安慰剂患者也受到了影响（P = 0.19）。预防结束时定植指数>0.25对侵袭性真菌感染的敏感性为76%，但特异性仅为69%。然而，基线时定植指数≤0.25对侵袭性真菌感染发生的阴性预测值为88%。氟康唑预防可减少中性粒细胞减少癌症患者的真菌定植及随后的侵袭性真菌感染。
