Campitelli Marco, Zeineddine Nabil, Samaha Ghassan, Maslak Stephen
Northwell Health at Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.
J Clin Med Res. 2017 Jun;9(6):451-456. doi: 10.14740/jocmr2992w. Epub 2017 Apr 26.
The incidence of invasive fungal infections has been on the rise, particularly in transplant recipients and in patients with hematological malignancies and other forms of immunosuppression. There is a mismatch between the rate of antifungal resistance and the development of new antifungal agents. Based on this, the idea of combining antifungals in the treatment of invasive fungal infections appears tempting for many clinicians, particularly after many studies showed synergism between many antifungal agents. Several randomized controlled trials have been published regarding the efficacy and safety of combination of antifungals, but the high cost, the limited number of cases and the multitude of confounding factors lead in some instances to weak and sometimes contradictory results. The lack of consensus in many clinical scenarios raises the importance of the need for more studies about combination antifungal therapies and should incite infectious disease societies to develop specific recommendations for the clinicians to follow while approaching patients with invasive fungal infections.
侵袭性真菌感染的发病率一直在上升，尤其是在移植受者以及血液系统恶性肿瘤患者和其他免疫抑制形式的患者中。抗真菌耐药率与新型抗真菌药物的研发之间存在不匹配。基于此，对于许多临床医生来说，联合使用抗真菌药物治疗侵袭性真菌感染的想法似乎很有吸引力，特别是在许多研究表明多种抗真菌药物之间存在协同作用之后。关于抗真菌药物联合使用的疗效和安全性，已经发表了几项随机对照试验，但高成本、病例数量有限以及众多混杂因素有时会导致结果不明确甚至相互矛盾。在许多临床情况下缺乏共识，这凸显了对联合抗真菌治疗进行更多研究的必要性，并应促使传染病学会为临床医生在治疗侵袭性真菌感染患者时制定具体的遵循建议。
