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《2014年血液系统恶性肿瘤和造血干细胞移植中侵袭性霉菌感染治疗的共识指南》

Consensus guidelines for the treatment of invasive mould infections in haematological malignancy and haemopoietic stem cell transplantation, 2014.

作者信息

Blyth C C, Gilroy N M, Guy S D, Chambers S T, Cheong E Y, Gottlieb T, McGuinness S L, Thursky K A

机构信息

School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia; Department of General Paediatrics, Princess Margaret Hospital for Children, Subiaco, Western Australia; PathWest Laboratory Medicine WA, Subiaco, Western Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia.

出版信息

Intern Med J. 2014 Dec;44(12b):1333-49. doi: 10.1111/imj.12598.

Abstract

Mould species represent the pathogens most commonly associated with invasive fungal disease in patients with haematological malignancies and patients of haemopoietic stem cell transplants. Invasive mould infections in these patient populations, particularly in the setting of neutropenia, are associated with high morbidity and mortality, and significantly increase the complexity of management. While Aspergillus species remain the most prevalent cause of invasive mould infections, Scedosporium and Fusarium species and the Mucormycetes continue to place a significant burden on the immunocompromised host. Evidence also suggests that infections caused by rare and emerging pathogens are increasing within the setting of broad-spectrum antifungal prophylaxis and improved survival times placing immunosuppressed patients at risk for longer. These guidelines present evidence-based recommendations for the antifungal management of common, rare and emerging mould infections in both adult and paediatric populations. Where relevant, the role of surgery, adjunctive therapy and immunotherapy is also discussed.

摘要

霉菌种类是血液系统恶性肿瘤患者和造血干细胞移植患者侵袭性真菌病最常见的相关病原体。在这些患者群体中,侵袭性霉菌感染,尤其是在中性粒细胞减少的情况下,与高发病率和高死亡率相关,并显著增加了管理的复杂性。虽然曲霉菌种仍然是侵袭性霉菌感染最常见的病因,但赛多孢属和镰刀菌属以及毛霉菌纲继续给免疫功能低下的宿主带来沉重负担。有证据还表明,在广谱抗真菌预防和生存时间延长的情况下,由罕见和新出现的病原体引起的感染正在增加,使免疫抑制患者面临更长时间的风险。本指南针对成人和儿童群体中常见、罕见和新出现的霉菌感染的抗真菌管理提出了循证建议。在相关情况下,还讨论了手术、辅助治疗和免疫治疗的作用。

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