Playford Elliott Geoffrey, Sorrell Tania C
Infection Management Services, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland 4102, Australia.
Semin Respir Crit Care Med. 2007 Dec;28(6):678-88. doi: 10.1055/s-2007-996415.
The problem of invasive candidiasis among ICU patients is an increasing and evolving one. Despite advances in supportive care, increasing numbers of critically ill and vulnerable patients are susceptible to infection, and the clinical consequences for those who do develop invasive candidiasis remain poor. Evolving epidemiological trends, particularly a relative increase in the incidence of fluconazole-resistant Candida spp., have further complicated management. The recent availability of antifungal agents, such as voriconazole, the echinocandins, and lipid-associated amphotericin B preparations, with improved safety profiles, extended spectra, and proven clinical efficacies, offers new therapeutic options. However, optimizing therapy requires the consideration of numerous factors: the differing pharmacological properties of these agents, cost, the clinical status and progress of the patient, estimates of the likelihood of resistance, and microbiological data as they become available. Because early institution of antifungal therapy appears an important determinant of favorable outcome, accurate early microbiological and clinical markers of invasive candidiasis to guide early antifungal interventions are desperately needed and remain an area of active investigation.
重症监护病房（ICU）患者侵袭性念珠菌病问题日益严重且不断演变。尽管支持性治疗取得了进展，但越来越多病情危重且易受感染的患者仍易发生感染，而那些确实发生侵袭性念珠菌病的患者临床预后仍然很差。不断演变的流行病学趋势，尤其是耐氟康唑念珠菌属发病率的相对增加，使治疗管理更加复杂。最近可用的抗真菌药物，如伏立康唑、棘白菌素类药物以及脂质体两性霉素B制剂，具有改善的安全性、更广的抗菌谱和已证实的临床疗效，提供了新的治疗选择。然而，优化治疗需要考虑众多因素：这些药物不同的药理学特性、成本、患者的临床状况和进展、耐药可能性的评估以及可得的微生物学数据。由于早期进行抗真菌治疗似乎是良好预后的一个重要决定因素，因此迫切需要准确的侵袭性念珠菌病早期微生物学和临床标志物来指导早期抗真菌干预，这仍然是一个积极研究的领域。
