Pôle d'Oncologie et d'Hématologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, Strasbourg, France.
J Infect. 2012 Apr;64(4):424-9. doi: 10.1016/j.jinf.2011.12.015. Epub 2011 Dec 29.
To describe and estimate the rate of breakthrough invasive mould diseases (IMD) in patients receiving caspofungin.
Retrospective, non-interventional study conducted in three University Hospitals.
Nineteen breakthrough infections have been identified including 13 aspergillosis, 2 mucormycosis, a fusariosis, a Hormographiella aspergillata infection and 2 possible IMD. Cases were equally distributed between the centres. Fourteen patients had a haematologic malignancy, four were transplant recipients (allogeneic haematopoietic stem cells in three, liver in one) and one had hepatic cirrhosis. Caspofungin has been prescribed as prophylaxis (n = 3), empirical therapy (n = 9) or directed therapy for candidemia (n = 5) or aspergillosis (n = 2). Aspergillus galactomannan was positive in serum or in bronchoalveolar lavage fluid in 10 of the 13 aspergillosis. Median duration of caspofungin treatment before breakthrough IMD was 15 days. Nine patients died within twelve weeks. Rate of breakthrough IMD in onco-haematology patients has been estimated to 7.3% for all mould infections and to 4.2% when restricted to documented aspergillosis.
Our data call for Aspergillus galactomannan monitoring and close clinical and radiological examination in case of persistence or recurrence of infection signs in high-risk patients receiving caspofungin.
描述并估计接受卡泊芬净治疗的患者中侵袭性霉菌病（IMD）突破性感染的发生率。
回顾性、非干预性研究，在三所大学医院进行。
共发现 19 例突破性感染，包括 13 例曲霉菌病、2 例毛霉菌病、1 例镰孢霉病、1 例棘孢木霉感染和 2 例可能的 IMD。病例在各中心分布均匀。14 例患者患有血液恶性肿瘤，4 例为移植受者（3 例为异基因造血干细胞移植，1 例为肝移植），1 例患有肝硬化。卡泊芬净已被处方用于预防（n=3）、经验性治疗（n=9）或针对念珠菌血症（n=5）或曲霉菌病（n=2）的定向治疗。13 例曲霉菌病中，10 例血清或支气管肺泡灌洗液中存在半乳甘露聚糖阳性的曲霉。在出现 IMD 突破性感染之前，卡泊芬净治疗的中位持续时间为 15 天。9 例患者在 12 周内死亡。在接受卡泊芬净治疗的血液恶性肿瘤患者中，所有霉菌感染的 IMD 突破性感染发生率估计为 7.3%，当仅限于有记录的曲霉菌病时，发生率为 4.2%。
我们的数据表明，在接受卡泊芬净治疗的高危患者中，如果感染迹象持续或复发，应进行曲霉半乳甘露聚糖监测和密切的临床及影像学检查。
