Controversies in Candida management
Controversies in Candida management
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DOI：
10.1016/j.ijantimicag.2015.10.008
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发表时间：
2015-12-01
影响因子：
10.8
通讯作者：
Kanj, S. S.
中科院分区：
文献类型：
--
作者：
El Zakhem, A.;Saad, H.;Kanj, S. S.
侵袭性念珠菌病（IC）与发病率和死亡率增加有关。虽然这种感染的诊断和治疗已经取得了进展，但仍然存在一些争议。这篇评论的目的是解决其中的一些争议，并阐明支持不同观点的研究。关于中心静脉导管相关的念珠菌血症，目前的证据似乎更支持尽可能早期中心静脉导管移除。否则，抗真菌剂如棘白菌素或多烯类应是首选药物。在近平滑念珠菌感染的情况下，鉴于棘白菌素的最低抑菌浓度（MIC）较高，唑类被认为是首选治疗药物。然而，最近的一项研究似乎表明，经验棘白菌素的使用与更坏的结果时，分离的物种是C。近平滑抗真菌治疗的不同策略已被考虑，即预防性，经验性，先发制人或定向治疗。虽然对高危癌症患者，特别是血液系统恶性肿瘤和干细胞移植人群的预防需求达成了共识，但预防是否对极低出生体重儿和重症监护室（ICU）患者有益仍存在争议。在抗真菌耐药性时代和提倡抗真菌管理的时代，基于各种念珠菌风险评分和敏感的非培养生物标志物（如β-D-葡聚糖）的预测模型的先发制人治疗似乎是一种更具成本效益的方法。未来的努力应致力于优化临床预测模型和可靠的生物标志物，以早期检测IC。(C)2015年Elsevier B. V.和国际化疗学会。All rights reserved.
Invasive candidiasis (IC) is associated with increased morbidity and mortality. Although advances in diagnosis and management of this infection have been reached, there remain several controversies. The aim of this review is to tackle some of these controversies and shed light on studies that support the different sides of the arguments. Regarding central line-associated candidaemia, the current evidence appears to be more in favour of early central line removal whenever possible. Otherwise, antifungal agents such as echinocandins or polyenes should be the preferred agents. In the setting of infection with Candida parapsilosis and in light of the high minimum inhibitory concentrations (MICs) to echinocandins, azoles have been considered the preferred treatment agents. However, a recent study appears to indicate that empirical echinocandin use was not associated with a worse outcome when the isolated species was C. parapsilosis. Different strategies of antifungal treatment have been considered, namely prophylactic, empirical, pre-emptive or directed therapies. Whilst there is consensus on the need for prophylaxis in high-risk cancer patients, especially haematological malignancy and stem cell transplant populations, it remains debatable whether prophylaxis is of benefit in very low birthweight infants and in intensive care unit (ICU) patients. In the era of antifungal resistance and where antifungal stewardship has been advocated, pre-emptive therapy based on predictive models with various Candida risk scores and sensitive non-culture-based biomarkers such as p-D-glucan appears to be a more cost-effective approach. Future efforts should be directed to optimise clinical predictive models and reliable biomarkers for early detection of IC. (C) 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.