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血液系统恶性肿瘤患者曲霉病的危险因素及环境预防措施

Risk Factors and Environmental Preventive Actions for Aspergillosis in Patients with Hematological Malignancies.

作者信息

Raposo Puglia Daniel, Raposo Puglia José Ángel, García-Cabrera Emilio, Morales Fátima, Camacho-Vega Juan Carlos, Vilches-Arenas Ángel

机构信息

Department of General and Digestive Surgery, Hospital Universitario Jerez de la Frontera, Ronda de Circunvalación s/n, 11407 Jerez de la Frontera, Spain.

Department of Hematology, Hospital Universitario Puerta del Mar, Ana de Viya, 21, 11009 Cádiz, Spain.

出版信息

Clin Pract. 2024 Feb 5;14(1):280-292. doi: 10.3390/clinpract14010022.

Abstract

(1) Background: spp. is a widely distributed filamentous fungus in the environment due to its high sporulation capacity. Currently, invasive aspergillosis (IA) is the most common invasive fungal infection in patients with hematologic malignancies, with high rates of mortality and morbidity. The multifactorial nature of the disease requires appropriate risk stratification to enable the most appropriate preventive measures to be adapted and implemented according to the characteristics of the patient. In this sense, the present research aims to identify recent risk factors and environmental control measures against invasive aspergillosis to establish preventive actions to reduce the incidence of invasive aspergillosis in hospitals. (2) Methods: We conducted a qualitative systematic review of the scientific literature on environmental risk factors and preventive measures for invasive aspergillosis in patients with hematologic malignancies. The Medline, Cochrane, and Scopus databases were consulted, following the PRISMA and STROBE guidelines. (3) Results: Adequate implementation of environmental control measures is presented as the most efficient intervention in terms of prevention to decrease the incidence of invasive aspergillosis in hospitals. Neutropenia, fungal contamination, insufficient environmental control measures in hospital and home settings, length of hospital stay, and anemia, are identified as independent risk factors. We show that HEPA, LAF, and Plasmair systems are suitable methods to reduce the concentration of airborne fungal spores. Antifungal prophylaxis did not significantly influence IA reduction in our study. (4) Conclusions: Proper professional training and environmental control measures in hospitals are essential for the prevention of invasive aspergillosis. We should optimize risk stratification for patients with hematologic malignancies. Antifungal prophylaxis should be complementary to environmental control measures and should never be substituted for the latter. Studies should also be undertaken to evaluate the efficiency of environmental control measures against IA at patients' homes.

摘要

(1) 背景:曲霉属真菌由于其高孢子形成能力,是环境中广泛分布的丝状真菌。目前,侵袭性曲霉病(IA)是血液系统恶性肿瘤患者中最常见的侵袭性真菌感染,死亡率和发病率很高。该疾病的多因素性质需要适当的风险分层,以便能够根据患者的特征调整和实施最合适的预防措施。从这个意义上说,本研究旨在确定侵袭性曲霉病的近期风险因素和环境控制措施,以建立预防行动,降低医院中侵袭性曲霉病的发病率。(2) 方法:我们对关于血液系统恶性肿瘤患者侵袭性曲霉病的环境风险因素和预防措施的科学文献进行了定性系统综述。遵循PRISMA和STROBE指南,查阅了Medline、Cochrane和Scopus数据库。(3) 结果:就预防而言,充分实施环境控制措施是降低医院中侵袭性曲霉病发病率的最有效干预措施。中性粒细胞减少、真菌污染、医院和家庭环境中环境控制措施不足、住院时间和贫血被确定为独立风险因素。我们表明,高效空气过滤器(HEPA)、层流空气(LAF)和等离子体空气系统是降低空气中真菌孢子浓度的合适方法。在我们的研究中,抗真菌预防对降低IA没有显著影响。(4) 结论:医院中适当的专业培训和环境控制措施对于预防侵袭性曲霉病至关重要。我们应该优化血液系统恶性肿瘤患者的风险分层。抗真菌预防应作为环境控制措施的补充,绝不能替代后者。还应开展研究,评估患者家中针对IA的环境控制措施的效果。

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