Kim Jong Hun, Williams Kali
Division of Infectious Diseases, Department of Internal Medicine, University of Utah, SOM 4B319 30 N 1900 E, Salt Lake City, UT, 84132, USA,
Mycopathologia. 2014 Oct;178(3-4):259-65. doi: 10.1007/s11046-014-9792-y. Epub 2014 Aug 8.
Invasive fungal infection (IFI) is an important cause of morbidity and mortality. Posaconazole is a second generation triazole with a broad spectrum, and it may be suitable for salvage antifungal treatment although posaconazole is not usually considered to be as first-line antifungal therapy for IFI. The purpose of this study was to assess the utility of posaconazole salvage treatment for IFI. We conducted a retrospective review of patients with salvage antifungal treatment with posaconazole for IFI at our institution between December 2007 and July 2012. A total of ten patients received posaconazole salvage IFI. Etiology of IFI was consisting of mucormycosis (four patients), Paecilomyces variotii (one patient), and unspecified IFI etiology (five patients). Causes of posaconazole treatment were following; intolerance of previous antifungal therapy in five patients, refractory IFI on previous antifungal therapy in four patients, and both intolerance of previous antifungal therapy and refractory IFI on previous antifungal therapy in one patient. Duration of posaconazole salvage treatment ranged from 15 to 355 days with median 47 days. The overall successful posaconazole salvage treatment response rate was 80.0 % (8 of 10 patients). There were three patients who died during the study period. However, only one death was attributed to the progression of IFI. Two patients discontinued posaconazole due to adverse events. Posaconazole salvage treatment was effective antifungal therapy for IFI. Further studies are needed to define the optimal therapeutic strategy.
侵袭性真菌感染（IFI）是发病和死亡的重要原因。泊沙康唑是一种第二代三唑类药物，具有广谱抗菌作用，尽管通常不认为泊沙康唑是IFI的一线抗真菌治疗药物，但它可能适用于挽救性抗真菌治疗。本研究的目的是评估泊沙康唑挽救性治疗IFI的效用。我们对2007年12月至2012年7月期间在我院接受泊沙康唑挽救性抗真菌治疗的IFI患者进行了回顾性研究。共有10例患者接受了泊沙康唑挽救性治疗IFI。IFI的病因包括毛霉菌病（4例）、拟青霉（1例）和未明确的IFI病因（5例）。泊沙康唑治疗的原因如下：5例患者对先前的抗真菌治疗不耐受，4例患者先前的抗真菌治疗后IFI难治，1例患者既对先前的抗真菌治疗不耐受且先前的抗真菌治疗后IFI难治。泊沙康唑挽救性治疗的持续时间为15至355天，中位数为47天。泊沙康唑挽救性治疗的总体成功缓解率为80.0%（10例患者中的8例）。在研究期间有3例患者死亡。然而，只有1例死亡归因于IFI的进展。2例患者因不良事件停用泊沙康唑。泊沙康唑挽救性治疗是IFI有效的抗真菌治疗方法。需要进一步研究来确定最佳治疗策略。
