Constantin J-M, Roszyk L, Guerin R, Bannier F, Chartier C, Perbet S, Futier E, Cayot-Constantin S, Sapin V, Bazin J-E
Pôle anesthésie-réanimation, service de réanimation adulte, hôpital Hôtel-Dieu, CHU de Clermont-Ferrand, boulevard Léon-Malfreyt, 63058 Clermont-Ferrand, France.
Ann Fr Anesth Reanim. 2008 Oct;27(10):819-24. doi: 10.1016/j.annfar.2008.06.013. Epub 2008 Oct 5.
Caspofungin has shown efficacy and very low toxicity in empirical antifungal therapy in refractory invasive Aspergillus infections and invasive candidiasis in neutropenic (or non) patients. To date, there is no data on tolerability of caspofungin in ICU patients. The aim of this study was to evaluate caspofungine tolerability in critical care patients.
Over a 36-month period, 1430 patients were admitted in a general intensive care unit. All patients data were collected in a prospective database. All the clinical or biological side effects reported in the multicentric studies were required. The patients were laminated in two groups, according to the initial hepatic function.
Seventy-three patients were treated with caspofungin (5.1%) and 58% were immunocompromised. Immunosuppression was due to acute leukemia (30%), solid organ transplant (20%) or other causes of immunosuppression. In this group, SAPS2 was higher (51+/-20 versus 44+/-20; p<0.05) as mortality rate was (60% versus 23%). More than 90% of patients were ventilated and 55% needed extrarenal therapy. Caspofungin treatment was initiated for aspergillosis in 12 patients, candidiasis in 33 patients and others indications. Partial or complete response to treatment was 72%. Median duration of caspofungin administration was 11 days, no liver dysfunction or acute renal failure due to caspofungin was reported whatever initial liver function was.
This prospective open study demonstrate the very low toxicity of caspofungin even in critical care patients.
卡泊芬净在难治性侵袭性曲霉感染及中性粒细胞减少（或非中性粒细胞减少）患者的侵袭性念珠菌病的经验性抗真菌治疗中已显示出疗效且毒性极低。迄今为止，尚无关于卡泊芬净在重症监护病房（ICU）患者中耐受性的数据。本研究的目的是评估卡泊芬净在危重症患者中的耐受性。
在36个月的时间里，1430例患者入住一家综合性重症监护病房。所有患者的数据均收集于一个前瞻性数据库中。需要多中心研究中报告的所有临床或生物学副作用。根据初始肝功能将患者分为两组。
73例患者接受了卡泊芬净治疗（5.1%），58%的患者免疫功能低下。免疫抑制是由急性白血病（30%）、实体器官移植（20%）或其他免疫抑制原因引起的。在该组中，简化急性生理学评分系统Ⅱ（SAPS2）更高（51±20对44±20；p<0.05），死亡率也更高（60%对23%）。超过90%的患者需要机械通气，55%的患者需要肾外治疗。12例患者因曲霉病开始使用卡泊芬净治疗，33例患者因念珠菌病开始使用，另有其他适应证。治疗的部分或完全缓解率为72%。卡泊芬净给药的中位持续时间为11天，无论初始肝功能如何，均未报告因卡泊芬净导致的肝功能障碍或急性肾衰竭。
这项前瞻性开放研究表明，即使在危重症患者中，卡泊芬净的毒性也极低。
