Denning David W, Perlin David S, Muldoon Eavan G, Colombo Arnaldo Lopes, Chakrabarti Arunaloke, Richardson Malcolm D, Sorrell Tania C
Emerg Infect Dis. 2017 Feb;23(2):177-183. doi: 10.3201/eid2302.152042. Epub 2017 Feb 15.
Antimicrobial resistance, a major public health concern, largely arises from excess use of antibiotic and antifungal drugs. Lack of routine diagnostic testing for fungal diseases exacerbates the problem of antimicrobial drug empiricism, both antibiotic and antifungal. In support of this contention, we cite 4 common clinical situations that illustrate this problem: 1) inaccurate diagnosis of fungal sepsis in hospitals and intensive care units, resulting in inappropriate use of broad-spectrum antibacterial drugs in patients with invasive candidiasis; 2) failure to diagnose chronic pulmonary aspergillosis in patients with smear-negative pulmonary tuberculosis; 3) misdiagnosis of fungal asthma, resulting in unnecessary treatment with antibacterial drugs instead of antifungal drugs and missed diagnoses of life-threatening invasive aspergillosis in patients with chronic obstructive pulmonary disease; and 4) overtreatment and undertreatment of Pneumocystis pneumonia in HIV-positive patients. All communities should have access to nonculture fungal diagnostics, which can substantially benefit clinical outcome, antimicrobial stewardship, and control of antimicrobial resistance.
抗菌药物耐药性是一个重大的公共卫生问题，主要源于抗生素和抗真菌药物的过度使用。缺乏针对真菌疾病的常规诊断检测加剧了抗菌药物经验性使用的问题，包括抗生素和抗真菌药物。为支持这一观点，我们列举4种常见临床情况来说明这一问题：1）医院和重症监护病房对真菌败血症的诊断不准确，导致侵袭性念珠菌病患者不恰当地使用广谱抗菌药物；2）涂片阴性肺结核患者未能诊断出慢性肺曲霉病；3）真菌性哮喘误诊，导致不必要地使用抗菌药物而非抗真菌药物治疗，以及慢性阻塞性肺疾病患者漏诊危及生命的侵袭性曲霉病；4）HIV阳性患者肺孢子菌肺炎的过度治疗和治疗不足。所有社区都应能够获得非培养真菌诊断方法，这可显著改善临床结局、抗菌药物管理及抗菌药物耐药性控制。
