Infectious Diseases, Christiana Care Health System, Newark, DE, USA.
Ann Pharmacother. 2010 Mar;44(3):546-56. doi: 10.1345/aph.1M377. Epub 2010 Feb 23.
To review the data supporting available antifungal agents and compare regimens utilized to prevent fungal infection in lung transplant recipients.
Literature retrieval was accessed through MEDLINE (1950 through October 2009) and United Network for Organ Sharing online database (available data through October 2009), using the terms lung transplantation, prophylaxis, and fungal infection. In addition, reference citations from publications identified were reviewed.
All articles or related abstracts in English identified from the data sources above were evaluated. Literature including adult lung transplant recipients who received systemic antifungal prophylaxis to prevent invasive fungal infections (IFIs) was included in the review.
IFIs after lung transplantation remain a common postoperative problem and are associated with high mortality. The lung is the most vulnerable solid organ to be transplanted, as it is the main organ responsible for gas exchange and therefore the high risk for pulmonary-related IFIs. It is most susceptible to developing an IFI, as it serves as a medium for organisms traveling from air to human tissue, potentially causing life-threatening infections. Such infections typically involve Candida and Aspergillus spp. and tend to occur within the first 12 months after transplant. Although there has been an increase in lung transplants performed over the past decade, no standard antifungal prophylactic regimen exists. Literature describing antifungals used to prevent IFI after transplant is scarce, which may be due to a lack of consistency in regimens used between transplant centers. Several regimens have been described utilizing different antifungal agents as both monotherapy and combination therapy. The majority of the literature reviewed here describes aerosolized amphotericin B formulations and azole antifungals demonstrating an overall decreased risk of fungal infection after lung transplantation. It has become the standard of practice to initiate some form of antifungal prophylaxis in these patients.
The risk of fungal infection after lung transplant is multifactorial and optimal prophylactic regimens should include agents with adequate activity against the most pathogenic fungi.
回顾支持现有抗真菌药物的数据，并比较用于预防肺移植受者真菌感染的方案。
通过 MEDLINE（1950 年至 2009 年 10 月）和 United Network for Organ Sharing 在线数据库（可获取截至 2009 年 10 月的数据）进行文献检索，使用术语肺移植、预防和真菌感染。此外，还审查了出版物中的参考文献。
评估了从上述数据源确定的所有英文文章或相关摘要。本综述包括接受全身抗真菌预防以预防侵袭性真菌感染（IFI）的成人肺移植受者的文献。
肺移植后 IFI 仍然是一个常见的术后问题，与高死亡率相关。肺是最容易受移植影响的实体器官，因为它是负责气体交换的主要器官，因此肺部相关 IFI 的风险很高。它最容易发生 IFI，因为它是生物体从空气传播到人体组织的媒介，可能导致危及生命的感染。此类感染通常涉及念珠菌和曲霉菌属，并且往往发生在移植后 12 个月内。尽管过去十年中肺移植的数量有所增加，但不存在标准的抗真菌预防方案。描述移植后预防 IFI 所用抗真菌药物的文献很少，这可能是由于移植中心之间使用的方案不一致。已经描述了几种方案，使用不同的抗真菌药物作为单一疗法和联合疗法。本文综述中描述的大多数文献都描述了雾化两性霉素 B 制剂和唑类抗真菌药，表明肺移植后真菌感染的总体风险降低。在这些患者中开始某种形式的抗真菌预防已成为常规做法。
肺移植后真菌感染的风险是多因素的，最佳预防方案应包括对最具致病性真菌具有足够活性的药物。
