Novak Alison R, Bradley Mary E, Kiser Tyree H, Mueller Scott W
Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA.
Curr Fungal Infect Rep. 2020 Jun;14(2):141-152. doi: 10.1007/s12281-020-00379-2. Epub 2020 Mar 26.
This review summarizes current treatment options for echinocandin-resistant spp. (ERC) and azole-resistant (ARAF), emphasizing recent data, clinical reports, and consensus statements.
Advances in ERC and ARAF treatment are limited to specific antifungal combinations and dose optimization but remain reliant on amphotericin products. Although novel antifungals may provide breakthroughs in the treatment of resistant fungi, these agents are not yet available. Early identification and appropriate treatment remain a paramount, albeit elusive, task.
When either ERC or ARAF are suspected or proven, amphotericin products remain the cornerstone of initial therapy. For ERC, azoles are de-escalation options for susceptible isolates in stable patients to avoid amphotericin toxicities. Although combination echinocandin with high-dose salvage posaconazole or isavuconazole may be attempted in ARAF, it requires careful consideration following patient stabilization. Future research defining optimal therapies and early identification of ERC and ARAF is of extreme importance.
本综述总结了针对棘白菌素耐药菌（ERC）和唑类耐药菌（ARAF）的当前治疗选择，重点介绍了近期数据、临床报告和共识声明。
ERC和ARAF治疗的进展仅限于特定的抗真菌联合用药和剂量优化，但仍依赖于两性霉素产品。尽管新型抗真菌药物可能会在耐药真菌治疗方面取得突破，但这些药物尚未问世。早期识别和适当治疗仍然是一项至关重要但难以捉摸的任务。
当怀疑或证实存在ERC或ARAF时，两性霉素产品仍然是初始治疗的基石。对于ERC，唑类药物是稳定患者中敏感菌株降阶梯治疗的选择，以避免两性霉素的毒性。尽管在ARAF中可尝试棘白菌素与高剂量挽救性泊沙康唑或艾沙康唑联合使用，但在患者病情稳定后需要仔细考虑。确定最佳治疗方案以及早期识别ERC和ARAF的未来研究极为重要。
