Klinikum der Universität München Großhadern, Medizinische Klinik und Poliklinik III, München.
Mycoses. 2013 Nov;56(6):651-8. doi: 10.1111/myc.12086. Epub 2013 May 26.
Since two large-scale, randomised studies on posaconazole prophylaxis have demonstrated a clear benefit for patients at high risk for contracting invasive fungal disease (IFD), posaconazole prophylaxis has been adopted as standard of care for this patient collective. Several years on from implementation at our institution, we wanted to evaluate its impact on the incidence and use of empirical antifungal therapy in a real-life setting. We analysed retrospectively incidence and severity of IFD in high-risk patients with prophylaxis, using a historical cohort as comparator. A total of 200 patients had either received the extended spectrum triazole posaconazole in prophylactic dosage of 200 mg tid or empirical antifungal therapy. Disease events were analysed by application of the revised EORTC/MSG definitions for IFD. Before posaconazole prophylaxis, we recorded 57/100 cases of IFD which was reduced to 28/100 with prophylaxis. The empirical use of antifungal drugs was reduced to 41% from 91% in the non-prophylaxis cohort. Furthermore, we observed a shift in the categorisation of IFD according to EORTC/MSG criteria. Our data suggest that posaconazole was effective in reducing the rate and probability of invasive fungal disease in high-risk patients.
由于两项大型随机研究表明泊沙康唑预防治疗对罹患侵袭性真菌感染（IFD）风险较高的患者具有明确益处，因此泊沙康唑预防治疗已被采纳为该患者群体的标准治疗方法。在我们的机构实施几年后，我们想在真实环境中评估其对经验性抗真菌治疗的发病率和使用的影响。我们回顾性地分析了预防性使用扩展谱三唑类泊沙康唑（每日 200 毫克，分 3 次服用）或经验性抗真菌治疗的高危患者的 IFD 的发病率和严重程度，并使用历史队列作为对照。共有 200 例患者接受了扩展谱三唑类泊沙康唑预防性治疗或经验性抗真菌治疗。采用修订后的 EORTC/MSG IFD 定义来分析疾病事件。在使用泊沙康唑预防之前，我们记录了 100 例 IFD 中有 57 例，而预防后减少至 100 例中有 28 例。非预防组中经验性使用抗真菌药物的比例从 91%降至 41%。此外，我们观察到根据 EORTC/MSG 标准 IFD 的分类发生了变化。我们的数据表明，泊沙康唑可有效降低高危患者 IFD 的发生率和概率。
