Invasive Fusariosis in the Voriconazole Era: Single-Center 13-Year Experience.
Invasive Fusariosis in the Voriconazole Era: Single-Center 13-Year Experience.
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DOI：
10.1093/ofid/ofv099
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发表时间：
2015-09
影响因子：
4.2
通讯作者：
Marty FM
中科院分区：
文献类型：
--
作者：
Stempel JM;Hammond SP;Sutton DA;Weiser LM;Marty FM
侵袭性镰刀菌病是免疫功能低下患者中的一种侵袭性真菌病。伏立康唑时代死亡率仍然很高。应系统地研究镰刀菌病的联合治疗。背景。 侵袭性镰刀菌病在免疫功能低下的患者中仍然是一种侵袭性感染，尽管不常见。方法。 我们识别了 2002 年 1 月至 2014 年 12 月期间的所有侵袭性镰刀菌病病例。我们记录了患者特征，包括临床表现、治疗和诊断后 6 周和 12 周的结果，以及物种鉴定和抗真菌药物敏感性。结果。 15 名患者被诊断患有已证实（12, 80%）或可能（3, 20%）镰刀菌病。中位年龄为 60 岁（范围为 26-78 岁），10 名患者为男性。潜在疾病包括血液恶性肿瘤（13 例，87%）、幼年特发性关节炎（1 例，7%）和三度烧伤（1 例，7%）。 5 名患者在诊断前接受了造血干细胞移植。 6 名患者（40%）接受全身性糖皮质激素治疗，11 名患者（73%）在诊断时出现长期中性粒细胞减少症。临床表现包括以下内容：皮肤/软组织感染（8例，53%）、发热性中性粒细胞减少症（4例，27%）、呼吸道感染（2例，13%）和化脓性关节炎（1例，7%）。 12 名患者接受伏立康唑治疗：6 名患者（40%）单独使用伏立康唑，4 名患者（27%）接受伏立康唑和特比萘芬治疗，2 名患者（13%）接受伏立康唑、特比萘芬和两性霉素治疗。一名患者（7%）单独接受特比萘芬治疗，另一名患者单独接受米卡芬净治疗。 4 名患者接受了手术清创术（4 名，27%）。对9个分离株进行了药敏试验； 8 证明伏立康唑最低抑制浓度≥4 µg/mL。诊断后6周和12周时的累积生存概率分别为66.7%和53.3%。结论。 与侵袭性镰刀菌病相关的死亡率仍然很高。尽管伏立康唑最低抑制浓度升高，但我们中心的累计死亡率仍低于之前的报告。应系统地研究镰刀菌病的联合治疗。
Invasive fusariosis is an aggressive fungal disease among immunocompromised patients. Mortality remains high in the voriconazole era. Combination therapy should be studied systematically for fusariosis. Background. Invasive fusariosis remains an aggressive, albeit infrequent infection in immunocompromised patients. Methods. We identified all cases of invasive fusariosis between January 2002 and December 2014. We recorded patient characteristics including clinical presentation, treatment, and outcomes at 6 and 12 weeks after diagnosis, as well as species identification and antifungal drug susceptibilities. Results. Fifteen patients were diagnosed with proven (12, 80%) or probable (3, 20%) fusariosis. Median age was 60 years (range, 26–78), and 10 patients were male. Underlying conditions included hematological malignancies (13, 87%), juvenile idiopathic arthritis (1, 7%), and third-degree burns (1, 7%). Five patients underwent hematopoietic stem-cell transplantation before diagnosis. Six patients (40%) received systemic glucocorticoids, and 11 patients (73%) had prolonged neutropenia at the time of diagnosis. Clinical presentations included the following: skin/soft tissue infection (8, 53%), febrile neutropenia (4, 27%), respiratory tract infection (2, 13%), and septic arthritis (1, 7%). Twelve patients were treated with voriconazole: 6 (40%) with voriconazole alone, 4 (27%) with voriconazole and terbinafine, and 2 (13%) with voriconazole, terbinafine, and amphotericin. One patient (7%) was treated with terbinafine alone, and another with micafungin alone. Four patients underwent surgical debridement (4, 27%). Susceptibility testing was performed on 9 isolates; 8 demonstrated voriconazole minimum inhibitory concentrations ≥4 µg/mL. The cumulative probability of survival was 66.7% and 53.3% at 6 and 12 weeks after diagnosis. Conclusions. Mortality associated with invasive fusariosis remains high. Cumulative mortality at our center was lower than previous reports despite elevated voriconazole minimum inhibitory concentrations. Combination therapy should be studied systematically for fusariosis.