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难治性真菌感染：三例病例报告凸显良好实践

Refractory fungal infection: Three case reports highlighting good practice.

作者信息

Barnes Rosemary, Enoch David A, Ingram Wendy, Martin Jessica, Clay Jennifer, Tyler Netta, White P Lewis

机构信息

Cardiff University School of Medicine, Heath Park Way, CF14 4YS, Cardiff, United Kingdom.

Cambridge University Hospitals NHS Foundation Trust, Hills Road, CB2 0QQ, Cambridge, United Kingdom.

出版信息

Med Mycol Case Rep. 2024 Dec 4;46:100688. doi: 10.1016/j.mmcr.2024.100688. eCollection 2024 Dec.

DOI:10.1016/j.mmcr.2024.100688
PMID:39759765
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11697122/
Abstract

Refractory invasive fungal disease is a significant clinical problem, with high morbidity, mortality and costs. The complex causes of refractory infection include breakthrough infection due to antifungal resistance (both innate and acquired), suboptimal therapy and impaired immune responses in critically ill or immunocompromised patients. This case series details three reports on the identification and management of refractory fungal infections, two cases of azole resistance and one case of resistant candidiasis, highlighting the importance of accurate diagnosis, monitoring, implementation of biomarkers (serological markers, PCR), antifungal susceptibility testing and antifungal stewardship to optimise management and minimise risks of emergence of drug resistance.

摘要

难治性侵袭性真菌病是一个重大的临床问题，具有高发病率、高死亡率和高成本。难治性感染的复杂原因包括由于抗真菌耐药性（先天性和获得性）导致的突破性感染、治疗不充分以及重症或免疫功能低下患者的免疫反应受损。本病例系列详细介绍了三篇关于难治性真菌感染的识别和管理的报告，两例唑类耐药病例和一例耐药念珠菌病病例，强调了准确诊断、监测、生物标志物（血清学标志物、聚合酶链反应）的应用、抗真菌药敏试验以及抗真菌管理对于优化治疗和最小化耐药性出现风险的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f47/11697122/412b9d03d2c7/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f47/11697122/712614198ae0/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f47/11697122/412b9d03d2c7/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f47/11697122/712614198ae0/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f47/11697122/412b9d03d2c7/gr2.jpg

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本文引用的文献

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Invasive pulmonary aspergillosis real-world outcomes: Clinical features and risk factors associated with increased mortality.侵袭性肺曲霉病的真实世界结局：与死亡率增加相关的临床特征和危险因素。
Med Mycol. 2023 Aug 2;61(8). doi: 10.1093/mmy/myad074.
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Mutations in the Species Complex: First Clue to Understand the Low Susceptibility to Azoles of the Genus .物种复合体中的突变：理解该属对唑类低敏感性的首要线索。
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Core Recommendations for Antifungal Stewardship: A Statement of the Mycoses Study Group Education and Research Consortium.抗真菌药物管理核心推荐：真菌病研究组教育和研究联盟的声明。
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Voriconazole Resistance and Mortality in Invasive Aspergillosis: A Multicenter Retrospective Cohort Study.伏立康唑耐药与侵袭性曲霉病患者死亡率的相关性：一项多中心回顾性队列研究。
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The global problem of antifungal resistance: prevalence, mechanisms, and management.全球抗真菌耐药性问题：流行率、机制和管理。
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