侵袭性真菌感染治疗新进展

摘要/Abstract

摘要： 随着免疫受损人群的增多,近年来侵袭性真菌感染的发生率逐渐升高,由此导致的致病率也逐年上升。如何及时诊断并有效的治疗侵袭性真菌感染已成为临床上面临的挑战之一。该文就侵袭性真菌感染的流行病学、病因学及现有的治疗策略等方面进行综述。

关键词: 侵袭性真菌感染, 流行病学, 抗真菌药, 治疗

Abstract: The incidence of invasive fungal infections(IFIs) had increased over the last decade with the rise of risk population of patients who suffered from immunologic deficit.The morbidity and mortality of IFIs are high and the management of these conditions is a great challenge.This article reviews the epidemiology of the IFIs,the recently developed antifungal agents and the newly therapeutic strategies.

Key words: invasive fungal infections, epidemiology, antifungal agents, treatment

中图分类号:

R756.6

李梦, 廖万清. 侵袭性真菌感染治疗新进展[J]. 中国真菌学杂志, 2012, 7(1): 47-51.

LI Meng, LIAO Wan-qing. The situation in the treatment of invasive fungal infections[J]. Chinese Journal of Mycology, 2012, 7(1): 47-51.

参考文献

[1] Bennet JE.Echinocandins for candidemia in adults without neu-tropenia[J].N Engl J Med,2006,355(11):1154-1159.
[2] Pfaller MA,Pappas PG,Wingard JR.Invasive fungal patho-gens:current epidemiological trends[J].Clin Infect Dis,2006,43(Suppl 1):S3-14.
[3] Pfaller MA,Diekema DJ.Rare and emerging opportunistic fun-gal pathogens:concern for resistance beyond Candida albicansand Aspergillus fumigatus[J].J Clin Microbiol,2004,42(10):4419-4431.
[4] Segal BH,Almyroudis NG,Battiwalla M,et al.Prevention and early treatment of invasive fungal infection in patients with canc-er and neutropenia and in stem cell transplant recipients in theera of newer broad-spectrum antifungal agents and diagnostic ad-juncts[J].Clin Infect Dis,2007,44(3):402-409.
[5] Cornely OA,Maertens J,Bresnik M,et al.AmBiLoad Trial StudyGroup.Liposomal amphotericin B as initial therapy for invasivemold infection:a randomized trial comparing a high-loading doseregimen with standard dosing(AmBiLoad Trial)[J].Clin InfectDis,2007,44(10):1289-1297.
[6] Johnson LB,Kauffman CA.Voriconazole:a new triazole antifun-gal agent[J].Clin Infect Dis,2003,36(5):630-637.
[7] Dannaoui E,Meletiadis J,Mouton JW,et al.In vitro susceptibili-ties of zygomycetes to conventional and new antifungals[J].JAntimicrob Chemother,2003,51(1):45-52.
[8] Herbrecht R,Denning DW,Patterson TF,et al.Voriconazole ver-sus amphotericin B for primary therapy of invasive aspergillosis[J].N Engl J Med,2002,347(8):408-415.
[9] Perfect JR,Marr KA,Walsh TJ,et al.Voriconazole treatment forless common,emerging,or refractory fungal infections[J].ClinInfect Dis,2003,36(9):1122-1131.
[10] Ullmann AJ,Lipton JH,Vesole DH,et al.Posaconazole or flu-conazole for prophylaxis in severe graft-versus-host disease[J].N Engl J Med,2007,356(4):335-347.
[11] Cornely OA,Maertens J,Winston DJ,et al.Posaconazole vs.flu-conazole or itraconazole prophylaxis in patients with neutropenia[J].N Engl J Med,2007,356(4):348-359.
[12] Keating GM,Figgitt DP.Caspofungin:a review of its use in oe-sophageal candidiasis,invasive candidiasis and invasive asper-gillosis[J].Drugs,2003,63(20):2235-2263.
[13] Groll AH,Kolve H.Antifungal agents:in vitro susceptibilitytesting,pharmacodynamics,and prospects for combination ther-apy[J].Eur J Clin Microbiol Infect Dis,2004,23(4):256-270.
[14] Paphitou NI,Ostrosky-Zeichner L,Paetznick VL,et al.In vitroantifungal susceptibilities of Trichosporon species[J].Antimi-crob Agents Chemother,2002,46(4):1144-1146.
[15] Petrovic J,Ngai A,Bradshaw S,et al.Efficacy and safety ofcaspofungin in solid organ transplant recipients[J].TransplantProc,2007,39(10):3117-3120.
[16] Mora-Duarte J,Betts R,Rotstein C,et al.Comparison of caspo-fungin and amphotericin B for invasive candidiasis[J].N EnglJ Med,2002,347(25):2020-2029.
[17] Maertens J,Raad I,Pettrikos G,et al.Efficacy and safety ofcaspofungin for the treatment of invasive aspergillosis in patientsrefractory to or intolerant of conventional antifungal therapy[J].Clin Infect Dis,2004,39(11):1563-1571.
[18] Wingard JR.Empirical antifungal therapy in treating febrile neu-tropenic patients[J].Clin Infect Dis,2004,39(Suppl 1):S38-43.
[19] Wheat LJ.Antigen detection,serology,and molecular diagnosisof invasive mycoses in the immunocompromised host[J].Transpl Infect Dis,2006,8(3):128-139.
[20] Glasmacher A,Prentice A,Gorschluter M,et al.Itraconazole pre-vents invasive fungal infections in neutropenic patients treatedfor hematologic malignancies:evidence from a meta-analysis of3,597 patients[J].J Clin Oncol,2003,21(24):4615-4626.
[21] 周新.侵袭性真菌感染的新动向和治疗新策略[J].实用临床医药杂志,2010,7(14):1-2.
[22] Caillot D,Couaillier JF,Bernard A,et al.Increasing volume andchanging characteristics of invasive pulmonary aspergillosis onsequential thoracic computed tomography scans in patients withneutropenia[J].J Clin Oncol,2001,19(1):253-259.
[23] Becker MJ,Lugtenburg EJ,Cornelissen JJ,et al.Galactomannandetection in computerized tomography-based broncho-alveolarlavage fluid and serum in haematological patients at risk for in-vasive pulmonary aspergillosis[J].Br J Haematol,2003,121(3):448-457.
[24] Walsh TJ,Raad I,Patterson TF,et al.Treatment of invasive as-pergillosis with posaconazole in patients who are refractory to orintolerant of conventional therapy:an externally controlled trial[J].Clin Infect Dis,2007,44(1):2-12.
[25] Hennen CR.Pharmacoeconomic evaluations of antifungal thera-pies[J].Curr Med Res Opin,2009,25(7):1751-1758.
[26] Arenas-Guzman R,Tosti A,Hay R,et al.Pharmacoeconomics—an aid to better decision-making[J].J Eur Acad Dermatol Ve-nereol,2005,19 Suppl 1:34-39.
[27] Johnson MD,Kleinberg M,Danziger L,et al.Pharmacoeco-nomics of antifungal pharmacotherapy—challenges and futuredirections[J].Expert Opin Pharmacother,2005,6(15):2617-2632.
[28] Rubio-Terres C,Grau S.Pharmacoeconomics of voriconazole[J].Expert Opin Pharmacother,2010,11(6):877-887.
[29] Herbrecht R,Rajagopalan S,Danna R,et al.Comparative sur-vival and cost of antifungal therapy:posaconazole versus stand-ard antifungals in the treatment of refractory invasive aspergillo-sis[J].Curr Med Res Opin,2010,26(10):2457-2464.
[30] Spellberg BJ,Filler SG,Edwards JE.Current treatment strategiesfor disseminated candidiasis[J].Clin Infect Dis,2006,42(2):244-251.
[31] Garey KW,Rege M,Pai MP,et al.Time to initiation of flucon-azole therapy impacts mortality in patients with candidemia:amulti-institutional study[J].Clin Infect Dis,2006,43(1):25-31.