Vallejo Llamas J Carlos, Ruiz-Camps Isabel
Unidad de Trasplante Hematopoyético, Hospital Universitario Central de Asturias, Oviedo, España.
Enferm Infecc Microbiol Clin. 2012 Nov;30(9):572-9. doi: 10.1016/j.eimc.2012.08.003. Epub 2012 Oct 16.
Invasive fungal infection (IFI), caused by both yeasts and moulds, is a persistent problem, with high morbidity and mortality rates among patients on chemotherapy for haematology diseases, and hematopoietic stem cell transplant recipients. Management of IFI in these types of patients has become highly complex with the advent of new antifungals and diagnostic tests, resulting in different therapeutic strategies (prophylactic, empirical, pre-emptive, and targeted). A proper assessment of the risk for IFI of each individual patient appears to be critical in order to use the best prophylactic and therapeutic approach, and to increase the survival rates. Among the available antifungals, the most frequently used are fluconazole, mould-active azoles (itraconazole, posaconazole, voriconazole), candins (anidulafungin, caspofungin, micafungin), and amphotericin B (particularly its lipids formulations). Specific recommendations for use and the criteria for selection of antifungal agents are discussed in this paper.
侵袭性真菌感染(IFI)由酵母菌和霉菌引起,是一个长期存在的问题,在接受血液系统疾病化疗的患者以及造血干细胞移植受者中,发病率和死亡率都很高。随着新型抗真菌药物和诊断检测方法的出现,这类患者的IFI管理变得极为复杂,从而产生了不同的治疗策略(预防性、经验性、抢先性和靶向性)。为了采用最佳的预防和治疗方法并提高生存率,对每位患者的IFI风险进行恰当评估似乎至关重要。在现有的抗真菌药物中,最常用的是氟康唑、对霉菌有效的唑类药物(伊曲康唑、泊沙康唑、伏立康唑)、棘白菌素类(阿尼芬净、卡泊芬净、米卡芬净)以及两性霉素B(尤其是其脂质体制剂)。本文讨论了抗真菌药物的具体使用建议和选择标准。