Keighley Caitlin, Cooley Louise, Morris Arthur J, Ritchie David, Clark Julia E, Boan Peter, Worth Leon J
Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Camperdown, New South Wales, Australia.
Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead, New South Wales, Australia.
Intern Med J. 2021 Nov;51 Suppl 7:89-117. doi: 10.1111/imj.15589.
Patients with haematological malignancies, haemopoietic stem cell transplant recipients and patients requiring admission to intensive care settings are at high risk for invasive candidiasis (IC). Over the past decade, there has been increased reporting of non-albicans species and fluconazole resistance in Australia. These guidelines provide updated evidence-based recommendations for the diagnosis and management of IC in adult and paediatric haematology, oncology and intensive care settings. Optimal pharmacological and non-pharmacological management are discussed. Recent studies strengthen the recommendation for an echinocandin agent as first-line therapy for high-risk patients with IC. Mortality benefit has also been demonstrated for non-pharmacological management, including removal of central venous catheters, infectious diseases consultation and use of care bundles. Healthcare facilities managing immunocompromised patient populations should therefore adopt implementation strategies for these multimodal interventions.
血液系统恶性肿瘤患者、造血干细胞移植受者以及需要入住重症监护病房的患者发生侵袭性念珠菌病(IC)的风险很高。在过去十年中,澳大利亚非白念珠菌属物种和氟康唑耐药性的报告有所增加。这些指南为成人和儿童血液学、肿瘤学及重症监护环境中IC的诊断和管理提供了基于最新证据的建议。讨论了最佳的药物和非药物管理方法。最近的研究强化了将棘白菌素类药物作为IC高危患者一线治疗药物的建议。非药物管理(包括拔除中心静脉导管、传染病会诊和使用护理集束)也已证明可降低死亡率。因此,管理免疫功能低下患者群体的医疗机构应采用这些多模式干预措施的实施策略。