Infectious Diseases Unit, Pathophysiology Department, Laikon General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Int J Antimicrob Agents. 2012 Jun;39(6):464-71. doi: 10.1016/j.ijantimicag.2011.11.017. Epub 2012 Feb 14.
Invasive fungal infections (IFIs) have emerged as a major cause of morbidity and mortality amongst critically ill patients. Cancer patients admitted to the Intensive Care Unit (ICU) have multiple risk factors for IFIs. The vast majority of IFIs in the ICU are due to Candida spp. The incidence of invasive candidiasis (IC) has increased over recent decades, especially in the ICU. A shift in the distribution of Candida spp. from Candida albicans to non-albicans Candida spp. has been observed both in ICUs and oncology units in the last two decades. Timely diagnosis of IC remains a challenge despite the introduction of new microbiology techniques. Delayed initiation of antifungal therapy is associated with increased mortality. Therefore, prediction rules have been developed and validated prospectively in order to identify those ICU patients at high risk for IC and likely to benefit from early treatment. These rules, however, have not been validated in cancer patients. Similarly, major clinical studies on the efficacy of newer antifungals typically do not include cancer patients. Despite the introduction of more potent and less toxic antifungals, mortality from IFIs amongst cancer patients remains high. In recent years, aspergillosis and mucormycosis have also emerged as significant causes of morbidity and mortality amongst ICU patients with haematological cancer.
侵袭性真菌感染（IFI）已成为重症患者发病率和死亡率的主要原因。入住重症监护病房（ICU）的癌症患者有多种IFI 的风险因素。ICU 中绝大多数 IFI 是由念珠菌属引起的。侵袭性念珠菌病（IC）的发病率在最近几十年有所增加，尤其是在 ICU 中。在过去的二十年中，无论是在 ICU 还是肿瘤病房，念珠菌属的分布已经从白色念珠菌转变为非白色念珠菌属念珠菌属。尽管新的微生物学技术已经问世，但 IC 的及时诊断仍然是一个挑战。抗真菌治疗的延迟启动与死亡率增加有关。因此，已经制定并前瞻性验证了预测规则，以确定那些 ICU 患者有发生 IC 的高风险，并可能从早期治疗中受益。然而，这些规则尚未在癌症患者中得到验证。同样，关于新型抗真菌药物疗效的主要临床研究通常不包括癌症患者。尽管引入了更有效和毒性更小的抗真菌药物，但癌症患者的 IFI 死亡率仍然很高。近年来，曲霉菌病和毛霉菌病也已成为血液系统癌症 ICU 患者发病率和死亡率的重要原因。
