Murali S, Langston A
Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia, USA.
Transpl Infect Dis. 2009 Dec;11(6):480-90. doi: 10.1111/j.1399-3062.2009.00441.x. Epub 2009 Sep 1.
Invasive fungal infection (IFI) is associated with significant morbidity and mortality in patients with hematologic malignancies. There have been significant changes in the epidemiology and outcomes of IFI in this patient population, due in part to advances in transplant procedures, supportive care, and use of newer antifungal agents. A thorough knowledge of risk factors, potential causative organisms, and the safety and efficacy of appropriate antifungal agents is required to optimize treatment. Proper diagnosis of IFI is challenging and the correlation of delays in diagnosis and treatment with poor outcome suggest that earlier intervention may result in more effective management of high-risk patients. Because all risks may not be equal, stratifying high-risk patients may further help target patients most likely to benefit from prophylaxis. This review focuses on various risk factors specific to patients with hematologic malignancies and discusses the use of preemptive, empiric, and prophylactic strategies in the management of IFI in this patient population.
侵袭性真菌感染（IFI）与血液系统恶性肿瘤患者的高发病率和死亡率相关。该患者群体中IFI的流行病学和预后已发生显著变化，部分原因是移植手术、支持治疗以及新型抗真菌药物使用方面的进展。为优化治疗，需要全面了解危险因素、潜在致病微生物以及合适抗真菌药物的安全性和有效性。IFI的准确诊断具有挑战性，诊断和治疗延迟与不良预后之间的相关性表明，早期干预可能会使高危患者得到更有效的管理。由于所有风险可能并不相同，对高危患者进行分层可能会进一步有助于确定最有可能从预防中获益的患者。本综述重点关注血液系统恶性肿瘤患者特有的各种危险因素，并讨论在该患者群体中管理IFI时先发制人、经验性和预防性策略的应用。
