Consensus guidelines for the treatment of invasive mould infections in haematological malignancy and haemopoietic stem cell transplantation, 2014
Consensus guidelines for the treatment of invasive mould infections in haematological malignancy and haemopoietic stem cell transplantation, 2014
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DOI：
10.1111/imj.12598
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发表时间：
2014-12-01
影响因子：
2.1
通讯作者：
Thursky, K. A.
中科院分区：
文献类型：
--
作者：
Blyth, C. C.;Gilroy, N. M.;Thursky, K. A.
霉菌是血液系统恶性肿瘤患者和造血干细胞移植患者中侵袭性真菌病最常见的病原体。这些患者人群中的侵袭性霉菌感染，特别是在中性粒细胞减少症的情况下，与高发病率和死亡率相关，并显著增加了管理的复杂性。虽然曲霉属物种仍然是侵入性霉菌感染的最普遍原因，但丝孢霉属和镰刀菌属物种以及毛霉属继续对免疫受损的宿主造成重大负担。证据还表明，在广谱抗真菌预防和改善生存时间的背景下，罕见和新兴病原体引起的感染正在增加，使免疫抑制患者处于更长的风险中。这些指南为成人和儿童人群中常见、罕见和新发霉菌感染的抗真菌治疗提供了循证建议。在相关的情况下，手术，免疫治疗和免疫治疗的作用也进行了讨论。
Mould species represent the pathogens most commonly associated with invasive fungal disease in patients with haematological malignancies and patients of haemopoietic stem cell transplants. Invasive mould infections in these patient populations, particularly in the setting of neutropenia, are associated with high morbidity and mortality, and significantly increase the complexity of management. While Aspergillus species remain the most prevalent cause of invasive mould infections, Scedosporium and Fusarium species and the Mucormycetes continue to place a significant burden on the immunocompromised host. Evidence also suggests that infections caused by rare and emerging pathogens are increasing within the setting of broad-spectrum antifungal prophylaxis and improved survival times placing immunosuppressed patients at risk for longer. These guidelines present evidence-based recommendations for the antifungal management of common, rare and emerging mould infections in both adult and paediatric populations. Where relevant, the role of surgery, adjunctive therapy and immunotherapy is also discussed.