Invasive candidiasis as a cause of sepsis in the critically ill patient.
Invasive candidiasis as a cause of sepsis in the critically ill patient.
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DOI：
10.4161/viru.26187
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发表时间：
2014-01-01
期刊：
影响因子：
5.2
通讯作者：
Calandra T
中科院分区：
文献类型：
--
作者：
Delaloye J;Calandra T
侵袭性真菌感染是危重患者中脓毒症的一种日益常见的病因，导致大量的发病率和死亡率。念珠菌属是迄今为止真菌性脓毒症的主要病原体，占卫生保健相关感染的10%至15%，约占所有严重脓毒症和脓毒性休克病例的5%，并且是美国第四大最常见的血流分离株。三分之一的念珠菌血症发生在重症监护环境中。侵袭性念珠菌病的早期诊断对于及时使用抗真菌药物至关重要。延迟给予适当的治疗会增加死亡率。不幸的是，危险因素，临床和放射学表现是相当不具体的和传统的文化方法是次优的。非培养方法（如甘露聚糖、抗甘露聚糖、β-d-葡聚糖和聚合酶链反应）已经出现，但仍处于研究阶段或需要在ICU环境中进行额外检测。在危重患者中进行的预防性或先发制人的研究很少。它们往往动力不足，在大多数情况下其临床有用性仍有待确定。抗真菌药物随着阿替霉素B、最新的三唑和棘白菌素的脂质制剂的出现而大大扩展。临床试验表明，三唑类和棘白菌素是有效的和耐受性良好的抗真菌治疗。侵袭性念珠菌病管理的临床实践指南已由欧洲临床微生物学和传染病学会和北美传染病学会出版。
Invasive fungal infections are an increasingly frequent etiology of sepsis in critically ill patients causing substantial morbidity and mortality. Candida species are by far the predominant agent of fungal sepsis accounting for 10% to 15% of health-care associated infections, about 5% of all cases of severe sepsis and septic shock and are the fourth most common bloodstream isolates in the United States. One-third of all episodes of candidemia occur in the intensive care setting. Early diagnosis of invasive candidiasis is critical in order to initiate antifungal agents promptly. Delay in the administration of appropriate therapy increases mortality. Unfortunately, risk factors, clinical and radiological manifestations are quite unspecific and conventional culture methods are suboptimal. Non-culture based methods (such as mannan, anti-mannan, β-d-glucan, and polymerase chain reaction) have emerged but remain investigational or require additional testing in the ICU setting. Few prophylactic or pre-emptive studies have been performed in critically ill patients. They tended to be underpowered and their clinical usefulness remains to be established under most circumstances. The antifungal armamentarium has expanded considerably with the advent of lipid formulations of amphotericin B, the newest triazoles and the echinocandins. Clinical trials have shown that the triazoles and echinocandins are efficacious and well tolerated antifungal therapies. Clinical practice guidelines for the management of invasive candidiasis have been published by the European Society for Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of North America.
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影响因子：
168.9
作者：
CALANDRA, T;SCHNEIDER, R;FRANCIOLI, P
通讯作者：
FRANCIOLI, P
影响因子：
38.9
作者：
Garbino, J;Lew, DP;Pittet, D
通讯作者：
Pittet, D
影响因子：
8.8
作者：
Hadley, S;Lee, WW;Nasraway, SA
通讯作者：
Nasraway, SA
影响因子：
11.8
作者：
Garey, Kevin W.;Rege, Milind;Bearden, David T.
通讯作者：
Bearden, David T.
DOI：
10.1111/j.1749-6632.2012.06805.x
发表时间：
2012-01-01
期刊：
ADVANCES AGAINST ASPERGILLOSIS I
影响因子：
--
作者：
Dimopoulos, George;Frantzeskaki, Frantezeska;Armaganidis, Apostolos
通讯作者：
Armaganidis, Apostolos