Division of Infectious Diseases, Toronto, Ontario ; University of Toronto, Toronto, Ontario.
Can J Infect Dis Med Microbiol. 2012 Winter;23(4):179-82. doi: 10.1155/2012/957973.
Caspofungin is an echinocandin class antifungal medication that is commonly used empirically in immunocompromised patients at high risk for invasive fungal disease.
To describe the clinical characteristics of breakthrough fungal infections in pediatric hematopoetic stem cell transplant recipients, and oncology and hematology patients receiving caspofungin.
A five-year retrospective review, from 2004 through 2008, of all cases of proven invasive filamentous fungal infection of children admitted to The Hospital for Sick Children (Toronto, Ontario) was conducted. A breakthrough infection was defined as new onset of symptoms that were later proven to be due to an invasive mold infection on day 3 or later after initiation of caspofungin therapy.
Six confirmed positive cultures (Aspergillus fumigatus [two cases], Aspergillus niger, Fusarium oxysporum, Alternaria infectoria and Rhizomucor pusillus) met the criteria for breakthrough filamentous mold infection while on caspofungin therapy. Underlying immunocompromising conditions included acute lymphoblastic leukemia (two cases), acute myeloid leukemia (two cases), Burkitt's lymphoma and aplastic anemia. Four of the patients underwent a hematopoetic stem cell transplant. All patients received a lipid amphotericin B product as part of their treatment for breakthrough infection. Five patients also received voriconazole and one received posaconazole. Four of the six patients died and two responded with a clinical and microbiological cure.
There are few descriptions of breakthrough fungal infections in pediatric patients receiving caspofungin. The six cases presented here, all microbiologically proven, are likely only a fraction of the total number of possible breakthrough invasive fungal infections that occured over the study period.
Clinicians must remain aware that breakthrough fungal infections by species not covered by particular antifungals, including caspofungin, do occur and may have poor outcomes.
卡泊芬净是棘白菌素类抗真菌药物，常用于免疫功能低下的高危侵袭性真菌感染患者的经验性治疗。
描述儿童造血干细胞移植受者、肿瘤和血液科患者接受卡泊芬净治疗时突破性真菌感染的临床特征。
对 2004 年至 2008 年期间入住多伦多 SickKids 医院的所有确诊侵袭性丝状真菌感染患儿的病例进行了为期 5 年的回顾性研究。突破性感染定义为在开始卡泊芬净治疗第 3 天或之后出现的新症状，后来证实这些症状是由侵袭性霉菌感染引起的。
6 例经确证的阳性培养（烟曲霉[2 例]、黑曲霉、构巢曲霉、枝孢霉和少根根霉）符合卡泊芬净治疗期间发生突破性丝状霉菌感染的标准。潜在的免疫功能低下情况包括急性淋巴细胞白血病（2 例）、急性髓细胞白血病（2 例）、伯基特淋巴瘤和再生障碍性贫血。4 例患者接受了造血干细胞移植。所有患者均接受了脂质两性霉素 B 产品治疗，作为突破性感染治疗的一部分。5 例患者还接受了伏立康唑治疗，1 例患者接受了泊沙康唑治疗。6 例患者中有 4 例死亡，2 例患者临床和微生物学治愈。
在接受卡泊芬净治疗的儿科患者中，突破性真菌感染的描述较少。这里报告的 6 例病例均经微生物学证实，可能只是研究期间发生的所有可能的突破性侵袭性真菌感染的一小部分。
临床医生必须意识到，包括卡泊芬净在内的特定抗真菌药物未覆盖的物种可能会发生突破性真菌感染，且可能预后不良。
