Cortés Jorge Alberto, Ruiz José Franklin, Melgarejo-Moreno Lizeth Natalia, Lemos Elkin V
Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Grupo de Investigación en Enfermedades Infecciosas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
Departamento Médico, Pfizer, Bogotá, D.C., Colombia.
Biomedica. 2020 Mar 1;40(1):195-207. doi: 10.7705/biomedica.4400.
In Colombia, especially in intensive care units, candidemia is a frequent cause of infection, accounting for 88% of fungal infections in hospitalized patients, with mortality ranging from 36% to 78%. Its incidence in Colombia is higher than that reported in developed countries and even higher than in other Latin American countries. First, the patient’s risk factors should be considered, and then clinical characteristics should be assessed. Finally, microbiological studies are recommended and if the evidence supports its use, molecular testing. In general, American, Latin American, and European guides place the echinocandins as the first-line treatment for candidemia and differ in the use of fluconazole based on evidence, disease severity, previous exposure to azoles, and prevalence of Candida non-albicans. Taking into account the high incidence of this disease in our setting, it should be looked for in patients with risk factors to start a prompt empirical anti-fungal treatment.
在哥伦比亚,尤其是在重症监护病房,念珠菌血症是常见的感染原因,占住院患者真菌感染的88%,死亡率在36%至78%之间。其在哥伦比亚的发病率高于发达国家报道的发病率,甚至高于其他拉丁美洲国家。首先,应考虑患者的危险因素,然后评估临床特征。最后,建议进行微生物学研究,如果有证据支持,还应进行分子检测。一般来说,美国、拉丁美洲和欧洲的指南将棘白菌素作为念珠菌血症的一线治疗药物,并且根据证据、疾病严重程度、先前接触唑类药物的情况以及非白色念珠菌的流行率,在氟康唑的使用上存在差异。考虑到该病在我们地区的高发病率,应在有危险因素的患者中进行筛查,以便尽早开始经验性抗真菌治疗。