De Pauw B E
Division of Hematology, University Hospital Nijmegen, The Netherlands.
Eur J Clin Microbiol Infect Dis. 1997 Jan;16(1):32-41. doi: 10.1007/BF01575119.
Invasive fungal infections have become a major obstacle to the treatment of patients with malignancies. Candida spp. and Aspergillus spp. now rank among the ten most prominent pathogens in these patients. Currently, there are no adequate means of detecting these infections at an early stage, and optimal hygiene and elimination of well-known sources of infection remain the most important preventive measures. Due to the lack of reliable, randomized studies, the role of antifungal drugs in the prevention of invasive fungal infections is difficult to judge. The clinical impact of the older oral antifungal agents is questionable, and compliance with therapeutic regimens of these drugs is often limited. In prospective studies in bone marrow transplant recipients, fluconazole was effective in preventing candidiasis but offered no prophylaxis against infections due to Aspergillus spp. and other molds. Initial trials on the use of sprays and aerosols of amphotericin B and on infusions of low doses of this drug appeared beneficial, but the number of patients included was too small to allow any definite conclusion. Itraconazole offers promise, but it can only be given orally; adequate, reliable absorption is not yet guaranteed. While the lack of data justifies a wait-and-see approach in patients at low or moderate risk of developing a fungal infection, it seems reasonable to administer prophylaxis to high-risk patients, even though there is presently no single agent suitable for all prophylactic purposes.
侵袭性真菌感染已成为恶性肿瘤患者治疗的一大障碍。念珠菌属和曲霉菌属现已位列这些患者中十大最主要的病原体。目前，尚无足够的手段在早期检测出这些感染，保持最佳卫生状况以及消除已知感染源仍是最重要的预防措施。由于缺乏可靠的随机研究，抗真菌药物在预防侵袭性真菌感染中的作用难以判定。较老的口服抗真菌药物的临床效果存疑，而且对这些药物治疗方案的依从性往往有限。在骨髓移植受者的前瞻性研究中，氟康唑在预防念珠菌病方面有效，但对曲霉菌属和其他霉菌引起的感染无预防作用。关于使用两性霉素B喷雾剂和气溶胶以及低剂量该药物静脉输注的初步试验似乎有益，但纳入的患者数量过少，无法得出任何明确结论。伊曲康唑有望发挥作用，但只能口服给药；其充分、可靠的吸收尚未得到保证。虽然缺乏数据证明对发生真菌感染低风险或中度风险的患者采取观望态度是合理的，但对高风险患者进行预防似乎是合理的，尽管目前尚无一种单一药物适用于所有预防目的。
