Department of Intensive Care Medicine and Burn Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Curr Opin Crit Care. 2010 Oct;16(5):465-9. doi: 10.1097/MCC.0b013e32833e0487.
Despite progress in the understanding of the pathophysiology of invasive candidiasis, and the development of new classes of well tolerated antifungals, invasive candidiasis remains a disease difficult to diagnose, and associated with significant morbidity and mortality. Early antifungal treatment may be useful in selected groups of patients who remain difficult to identify prospectively. The purpose of this review is to summarize the recent development of risk-identification strategies targeting early identification of ICU patients susceptible to benefit from preemptive or empirical antifungal treatment.
Combinations of different risk factors are useful in identifying high-risk patients. Among the many risk factors predisposing to invasive candidiasis, colonization has been identified as one of the most important. In contrast to prospective surveillance of the dynamics of colonization (colonization index), integration of clinical colonization status in risk scores models significantly improve their accuracy in identifying patients at risk of invasive candidiasis.
To date, despite limited prospective validation, clinical models targeted at early identification of patients at risk to develop invasive candidiasis represent a major advance in the management of patients at risk of invasive candidiasis. Moreover, large clinical studies using such risk scores or predictive rules are underway.
尽管人们对侵袭性念珠菌病的病理生理学有了深入的了解，并且开发了新的耐受良好的抗真菌药物，但侵袭性念珠菌病仍然难以诊断，并且与较高的发病率和死亡率相关。对于那些难以预测的特定患者群体，早期抗真菌治疗可能有用。本文旨在总结最近在确定风险策略方面的进展，旨在早期识别易受益于抢先或经验性抗真菌治疗的 ICU 患者。
不同风险因素的组合有助于识别高危患者。在易患侵袭性念珠菌病的众多危险因素中，定植被认为是最重要的因素之一。与前瞻性监测定植的动态（定植指数）相比，将临床定植状态纳入风险评分模型可显著提高识别侵袭性念珠菌病风险患者的准确性。
迄今为止，尽管前瞻性验证有限，但针对早期识别有侵袭性念珠菌病风险的患者的临床模型代表了侵袭性念珠菌病高危患者管理方面的重大进展。此外，正在使用此类风险评分或预测规则进行大型临床研究。
