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确保你有一个安全保障:干细胞移植受者感染性并发症预防与管理的最新进展

Make Sure You Have a Safety Net: Updates in the Prevention and Management of Infectious Complications in Stem Cell Transplant Recipients.

作者信息

Santos Carlos A Q, Rhee Yoona, Czapka Michael T, Kazi Aamir S, Proia Laurie A

机构信息

Rush University Medical Center, 600 S. Paulina St., Suite 143, Chicago, IL 60612, USA.

出版信息

J Clin Med. 2020 Mar 21;9(3):865. doi: 10.3390/jcm9030865.

Abstract

Hematopoietic stem cell transplant recipients are at increased risk of infection and immune dysregulation due to reception of cytotoxic chemotherapy; development of graft versus host disease, which necessitates treatment with immunosuppressive medications; and placement of invasive catheters. The prevention and management of infections in these vulnerable hosts is of utmost importance and a key "safety net" in stem cell transplantation. In this review, we provide updates on the prevention and management of CMV infection; invasive fungal infections; bacterial infections; infection; and EBV, HHV-6, adenovirus and BK infections. We discuss novel drugs, such as letermovir, isavuconazole, meropenem-vaborbactam and bezlotoxumab; weigh the pros and cons of using fluoroquinolone prophylaxis during neutropenia after stem cell transplantation; and provide updates on important viral infections after hematopoietic stem cell transplant (HSCT). Optimizing the prevention and management of infectious diseases by using the best available evidence will contribute to better outcomes for stem cell transplant recipients, and provide the best possible "safety net" for these immunocompromised hosts.

摘要

造血干细胞移植受者由于接受细胞毒性化疗、发生移植物抗宿主病(这需要使用免疫抑制药物治疗)以及置入侵入性导管,而面临感染和免疫失调风险增加的问题。在这些脆弱宿主中预防和管理感染至关重要,是干细胞移植中的关键“安全网”。在本综述中,我们提供了关于巨细胞病毒感染、侵袭性真菌感染、细菌感染、感染以及EB病毒、HHV-6、腺病毒和BK病毒感染的预防和管理的最新信息。我们讨论了新型药物,如莱特莫韦、艾沙康唑、美罗培南-巴坦和贝佐托昔单抗;权衡了干细胞移植后中性粒细胞减少期间使用氟喹诺酮预防的利弊;并提供了造血干细胞移植(HSCT)后重要病毒感染的最新信息。通过使用最佳现有证据优化传染病的预防和管理,将有助于干细胞移植受者获得更好的结果,并为这些免疫受损宿主提供尽可能好的“安全网”。

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