Glöckner Andreas, Steinbach Angela, Vehreschild Jörg Janne, Cornely Oliver A
Neurologisches Rehabilitationszentrum Greifswald, Greifswald, Germany.
Mycoses. 2009 Nov;52(6):476-86. doi: 10.1111/j.1439-0507.2008.01645.x.
Blood stream infections by Candida spp. represent the majority of invasive fungal infections in intensive care patients. The high crude mortality of invasive candidiasis remained essentially unchanged during the last two decades despite new treatment options that became available. The echinocandins, the latest class of antifungals introduced since 2001, exhibit potent activity against clinically relevant fungi including most Candida spp. In several randomised multicentre phase III trials, anidulafungin, caspofungin and micafungin showed convincing efficacy when compared with standard treatment regimens. In all trials, echinocandins were at least non-inferior to standard treatments. Anidulafungin was shown to be superior to fluconazole. Echinocandins have a favourable tolerability profile and exhibit a minimal potential for drug interactions since their pharmacokinetics is independent of renal and--largely--hepatic function. As a result of these properties, echinocandins are appropriate drugs of choice for invasive candidiasis in intensive care where many patients experience organ failure and receive multiple drugs with complex interactions.
念珠菌属引起的血流感染是重症监护患者侵袭性真菌感染的主要类型。尽管有了新的治疗选择，但在过去二十年中，侵袭性念珠菌病的高粗死亡率基本保持不变。棘白菌素是自2001年以来推出的最新一类抗真菌药物，对包括大多数念珠菌属在内的临床相关真菌具有强大活性。在几项随机多中心III期试验中，与标准治疗方案相比，阿尼芬净、卡泊芬净和米卡芬净显示出令人信服的疗效。在所有试验中，棘白菌素至少不劣于标准治疗。阿尼芬净被证明优于氟康唑。棘白菌素具有良好的耐受性，且由于其药代动力学独立于肾功能且在很大程度上独立于肝功能，因此药物相互作用的可能性极小。由于这些特性，棘白菌素是重症监护中侵袭性念珠菌病的合适首选药物，在重症监护中，许多患者会出现器官衰竭并接受多种具有复杂相互作用的药物治疗。
