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Advances in antifungal prophylaxis and empiric therapy in patients with hematologic malignancies.
恶性血液病患者行预防性抗真菌治疗和经验性治疗的研究进展

出处: Transpl Infect Dis   2009   Dec   11 (6) :480-90

作者:Murali S;Langston A

PMID:19725908

Invasive fungal infection (IFI) is associated with significant morbidity and mortality in patients with hematologic malignancies. There have been significant changes in the epidemiology and outcomes of IFI in this patient population, due in part to advances in transplant procedures, supportive care, and use of newer antifungal agents. A thorough knowledge of risk factors, potential causative organisms, and the safety and efficacy of appropriate antifungal agents is required to optimize treatment. Proper diagnosis of IFI is challenging and the correlation of delays in diagnosis and treatment with poor outcome suggest that earlier intervention may result in more effective management of high-risk patients. Because all risks may not be equal, stratifying high-risk patients may further help target patients most likely to benefit from prophylaxis. This review focuses on various risk factors specific to patients with hematologic malignancies and discusses the use of preemptive, empiric, and prophylactic strategies in the management of IFI in this patient population.

侵袭性真菌感染(IFI)是导致恶性血液病患者发病和死亡的重要原因之一。部分基于移植规程、支持疗法和新型抗真菌药物等方面取得的进展,IFI的流行病学和预后已发生明显变化。为了制定最佳的治疗方案,需要全面了解IFI的危险因素、潜在的病原体以及合理抗真菌治疗的安全性和有效性。IFI的恰当诊断具有挑战性,诊断和治疗的延误导致预后不良表明早期干预可为高危患者带来更为有效的疗效。由于所有的危险因素并不都等同,对高危患者进行分层可为患者从预防性用药中受益提供更好的靶向性。本文重点综述了恶性血液病患者特有的危险因素,并讨论了该类人群出现IFI的预先用药、经验性治疗和预防性用药策略。