Shanmugam Nirmala, Isenmann Rainer, Barkin Jamie S, Beger Hans G
University of Miami School of Medicine and Division of Gastroenterology, Mount Sinai Medical Center, Miami, Florida 33140, USA.
Pancreas. 2003 Aug;27(2):133-8. doi: 10.1097/00006676-200308000-00005.
There has been a steady rise in the incidence of pancreatic fungal infections. Even though fungal infections of the pancreas are not very common, they are often nosocomial.
To review pancreatic fungal infections and to compare their clinical characteristics with those of bacterial pancreatic infections, along with the causes and approaches to diagnosis and treatment.
Because of the lack of randomized, prospective trials, standardized recommendations for use of antifungal prophylaxis would be premature. The most important aspect of prophylaxis against pancreatic fungal infection is minimizing the factors that predispose the pancreas to fungal infections.
Isolation of fungal elements from necrotic pancreatic tissue and treatment of local infection are vital. Treatment of local candidal infection should be initiated with surgical necrosectomy. Systemic antifungal therapy should be started early in the course of the disease, but whether antifungal agents should be added to the prophylactic antibiotic regimens for patients with necrotizing pancreatitis remains questionable.
胰腺真菌感染的发病率一直在稳步上升。尽管胰腺真菌感染并不常见，但它们往往是医院获得性感染。
回顾胰腺真菌感染，并将其临床特征与细菌性胰腺感染的临床特征进行比较，同时探讨其病因、诊断方法和治疗方法。
由于缺乏随机、前瞻性试验，目前就使用抗真菌预防药物给出标准化建议还为时过早。预防胰腺真菌感染的最重要方面是尽量减少使胰腺易发生真菌感染的因素。
从坏死的胰腺组织中分离出真菌成分并治疗局部感染至关重要。局部念珠菌感染的治疗应首先进行手术清创。全身性抗真菌治疗应在疾病早期开始，但对于坏死性胰腺炎患者，是否应在预防性抗生素治疗方案中添加抗真菌药物仍存在疑问。
