Vallejo Carlos, Jarque Isidro, Fortun Jesus, Casado Araceli, Peman Javier
Hematology Department, Clinic University Hospital of Santiago de Compostela (CHUS), 15706 Santiago de Compostela, Spain.
Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain.
J Fungi (Basel). 2023 May 30;9(6):628. doi: 10.3390/jof9060628.
Recent advances in the treatment of hematologic malignancies have improved the overall survival rate, but the number of patients at risk of developing an invasive fungal infection (IFI) has increased. Invasive infections caused by non- species, non- molds, and azole-resistant have been increasingly reported in recent years. We developed a cross-sectional multicenter survey which involved a total of 55 hematologists and infectious disease specialists from a total of 31 Spanish hospitals, to determine the most frequent strategies used for the management of IFIs. Data collection was undertaken through an online survey which took place in 2022. Regarding key strategies, experts usually prefer early treatment for persistent febrile neutropenia, switching to another broad-spectrum antifungal family if azole-resistant is suspected, broad-spectrum azoles and echinocandins as prophylactic treatment in patients receiving midostaurin or venetoclax, and liposomal amphotericin B for breakthrough IFIs after prophylaxis with echinocandins in patients receiving new targeted therapies. For antifungals failing to reach adequate levels during the first days and suspected invasive aspergillosis, the most appropriate strategy would be to associate an antifungal from another family.
血液系统恶性肿瘤治疗的最新进展提高了总体生存率，但发生侵袭性真菌感染（IFI）风险的患者数量有所增加。近年来，由非念珠菌属、非霉菌以及对唑类耐药的病原体引起的侵袭性感染报告日益增多。我们开展了一项横断面多中心调查，共有来自西班牙31家医院的55名血液科医生和传染病专家参与，以确定管理IFI最常用的策略。数据收集通过2022年进行的在线调查完成。关于关键策略，专家们通常倾向于对持续性发热性中性粒细胞减少症进行早期治疗；如果怀疑对唑类耐药，则换用另一种广谱抗真菌药物类别；在接受米哚妥林或维奈克拉治疗的患者中，使用广谱唑类和棘白菌素作为预防性治疗；在接受新靶向治疗的患者中，在使用棘白菌素预防后出现突破性IFI时，使用脂质体两性霉素B进行治疗。对于在最初几天内未达到足够水平且怀疑侵袭性曲霉病的抗真菌药物，最合适的策略是联合使用另一类别的抗真菌药物。
