Chen S C, Sorrell T C, Chang C C, Paige E K, Bryant P A, Slavin M A
Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR - Pathology West, Westmead, New South Wales; Department of Infectious Diseases, Westmead Hospital, Westmead, New South Wales; Sydney Medical School, The University of Sydney, Sydney, New South Wales.
Intern Med J. 2014 Dec;44(12b):1315-32. doi: 10.1111/imj.12597.
Pathogenic yeast forms are commonly associated with invasive fungal disease in the immunocompromised host, including patients with haematological malignancies and patients of haemopoietic stem cell transplants. Yeasts include the Candida spp., Cryptococcus spp., Pneumocystis jirovecii and some lesser-known pathogens. Candida species remain the most common cause of invasive yeast infections (and the most common human pathogenic fungi). These guidelines present evidence-based recommendations for the antifungal management of established, invasive yeast infections in adult and paediatric patients in the haematology/oncology setting. Consideration is also given to the critically ill patient in intensive care units, including the neonatal intensive care unit. Evidence for 'pre-emptive' or 'diagnostic-driven antifungal therapy' is also discussed. For the purposes of this paper, invasive yeast diseases are categorised under the headings of invasive candidiasis, cryptococcosis and uncommon yeast infections. Specific recommendations for the management of Pneumocystis jirovecii are presented in an accompanying article (see consensus guidelines by Cooley et al. appearing elsewhere in this supplement).
致病性酵母形态通常与免疫功能低下宿主的侵袭性真菌病相关,包括血液系统恶性肿瘤患者和造血干细胞移植患者。酵母包括念珠菌属、隐球菌属、耶氏肺孢子菌以及一些不太知名的病原体。念珠菌属仍然是侵袭性酵母感染(也是最常见的人类致病真菌)的最常见病因。本指南针对血液学/肿瘤学环境中成人和儿童患者已确诊的侵袭性酵母感染的抗真菌治疗提出基于证据的建议。还考虑了重症监护病房中的重症患者,包括新生儿重症监护病房。也讨论了“抢先”或“诊断驱动的抗真菌治疗”的证据。为本文目的,侵袭性酵母病分类为侵袭性念珠菌病、隐球菌病和不常见的酵母感染。关于耶氏肺孢子菌管理的具体建议在随附文章中给出(见Cooley等人在本增刊其他地方发表的共识指南)。