Picazo Juan J, González-Romo Fernando, Candel F Javier
Department of Clinical Microbiology, Hospital Clinico San Carlos, Madrid, Spain.
Int J Antimicrob Agents. 2008 Nov;32 Suppl 2:S83-5. doi: 10.1016/S0924-8579(08)70005-0.
The frequency of invasive fungal infections caused by yeasts has increased in intensive care units. The most commonly isolated species is Candida albicans, although the number of non-albicans species isolated has increased, and associated mortality is greater in patients infected with these species. The factors that most frequently predispose to invasive candidiasis in the intensive care unit are alterations in skin and mucous barriers (catheters, surgery, intubation, etc.), renal insufficiency, parenteral nutrition, and therapy with corticosteroids or broad-spectrum antimicrobials. Early diagnosis of invasive fungal infections by detecting fungal DNA or invasiveness factors, such as (1-->3)-beta-D-glucan or antimycelial antibodies, and scores to predict and empirically treat invasive candidiasis, have proven very useful in reducing associated morbidity and mortality. In recent years there have been important advances in the development of antifungal agents, especially the new azoles and candins. The efficacy and safety profile of the candins make them the best option for treating invasive candidiasis in the critically ill patient.
重症监护病房中由酵母菌引起的侵袭性真菌感染的发生率有所增加。最常分离出的菌种是白色念珠菌，不过非白色念珠菌的分离数量也有所增加，并且感染这些菌种的患者的相关死亡率更高。重症监护病房中最常导致侵袭性念珠菌病的因素包括皮肤和黏膜屏障的改变（导管、手术、插管等）、肾功能不全、肠外营养以及使用皮质类固醇或广谱抗菌药物进行治疗。通过检测真菌DNA或侵袭性因子，如（1→3）-β-D-葡聚糖或抗菌丝抗体来早期诊断侵袭性真菌感染，以及用于预测和经验性治疗侵袭性念珠菌病的评分，已证明在降低相关发病率和死亡率方面非常有用。近年来，抗真菌药物的研发取得了重要进展，尤其是新型唑类和棘白菌素类药物。棘白菌素类药物的疗效和安全性使其成为治疗重症患者侵袭性念珠菌病的最佳选择。
