Sipsas Nikolaos V, Lewis Russell E, Raad Issam I, Kontoyiannis Dimitrios P
Department of Infectious Diseases, Infection Control and Employee Health, Unit 402, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
Int J Antimicrob Agents. 2009 Jul;34(1):95-8. doi: 10.1016/j.ijantimicag.2009.01.006. Epub 2009 Feb 28.
This study was performed to evaluate retrospectively the efficacy and safety of caspofungin monotherapy for candidaemia in patients with cancer. The medical records were reviewed of 63 consecutive adult patients with cancer who had candidaemia treated with caspofungin alone for at least 3 consecutive days at The University of Texas M.D. Anderson Cancer Center (March 2001-February 2007). Twenty patients (32%) had haematological malignancies. Most of the candidaemia cases (54%) were caused by non-albicans Candida spp. The most frequent isolates were C. albicans (38%) followed by Candidaparapsilosis (21%), Candidatropicalis (16%) and Candidaglabrata (10%). In vitro susceptibility studies showed that of 30 Candida isolates tested, only one C. parapsilosis isolate had a caspofungin minimum inhibitory concentration > 1 microg/mL. The clinical and mycological response rates after 7 days of treatment with caspofungin were 78% and 77%, respectively. The overall mortality rate was 5% on Day 7, 12% on Day 14 and 21% on Day 30. The 30-day Candida-attributable mortality rate was 11% and was significantly higher in patients with fluconazole-resistant or susceptible-dose-dependent Candida isolates. Caspofungin was well tolerated in all patients. Although selection of candidaemic patients with cancer who received caspofungin monotherapy may have accounted for the favourable outcomes, it was observed that caspofungin had efficacy and safety comparable with those in candidaemic patients without malignancy.
本研究旨在回顾性评估卡泊芬净单药治疗癌症患者念珠菌血症的疗效和安全性。回顾了得克萨斯大学MD安德森癌症中心（2001年3月至2007年2月）63例连续接受卡泊芬净单药治疗至少3天的成年癌症念珠菌血症患者的病历。20例（32%）患者患有血液系统恶性肿瘤。大多数念珠菌血症病例（54%）由非白色念珠菌引起。最常见的分离株是白色念珠菌（38%），其次是近平滑念珠菌（21%）、热带念珠菌（16%）和光滑念珠菌（10%）。体外药敏研究显示，在测试的30株念珠菌分离株中，只有1株近平滑念珠菌分离株的卡泊芬净最低抑菌浓度>1μg/mL。卡泊芬净治疗7天后的临床和真菌学反应率分别为78%和77%。第7天的总死亡率为5%，第14天为12%，第30天为21%。30天念珠菌归因死亡率为11%，在氟康唑耐药或剂量依赖性敏感念珠菌分离株患者中显著更高。所有患者对卡泊芬净耐受性良好。尽管选择接受卡泊芬净单药治疗的癌症念珠菌血症患者可能是取得良好结果的原因，但观察到卡泊芬净的疗效和安全性与无恶性肿瘤的念珠菌血症患者相当。
