Teh Benjamin W, Yeoh Daniel K, Haeusler Gabrielle M, Yannakou Costas K, Fleming Shaun, Lindsay Julian, Slavin Monica A
Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2021 Nov;51 Suppl 7:67-88. doi: 10.1111/imj.15588.
Antifungal prophylaxis can reduce morbidity and mortality from invasive fungal disease (IFD). However, its use needs to be optimised and appropriately targeted to patients at highest risk to derive the most benefit. In addition to established risks for IFD, considerable recent progress in the treatment of malignancies has resulted in the development of new 'at-risk' groups. The changing epidemiology of IFD and emergence of drug resistance continue to impact choice of prophylaxis, highlighting the importance of active surveillance and knowledge of local epidemiology. These guidelines aim to highlight emerging risk groups and review the evidence and limitations around new formulations of established agents and new antifungal drugs. It provides recommendations around use and choice of antifungal prophylaxis, discusses the potential impact of the changing epidemiology of IFD and emergence of drug resistance, and future directions for risk stratification to assist optimal management of highly vulnerable patients.
抗真菌预防可降低侵袭性真菌病（IFD）的发病率和死亡率。然而，其使用需要优化，并应适当地针对风险最高的患者，以获得最大益处。除了已明确的IFD风险因素外，近年来恶性肿瘤治疗取得了显著进展，导致了新的“高危”群体的出现。IFD不断变化的流行病学和耐药性的出现继续影响预防措施的选择，凸显了主动监测和了解当地流行病学的重要性。本指南旨在突出新兴风险群体，并回顾现有药物新剂型和新型抗真菌药物的证据及局限性。它提供了关于抗真菌预防的使用和选择的建议，讨论了IFD流行病学变化和耐药性出现的潜在影响，以及风险分层的未来方向，以协助对高危患者进行最佳管理。
