Invasive fungal infections in patients with cancer in the Intensive Care Unit

被引:71
作者
Sipsas, Nikolaos V. [2 ,3 ]
Kontoyiannis, Dimitrios P. [1 ]
机构
[1] Univ Texas MD Anderson Canc Ctr, Dept Infect Dis Infect Control & Employee Hlth, Unit 402, Houston, TX 77030 USA
[2] Natl & Kapodistrian Univ Athens, Infect Dis Unit, Dept Pathophysiol, Laikon Gen Hosp, Athens 11528, Greece
[3] Natl & Kapodistrian Univ Athens, Sch Med, Athens 11528, Greece
基金
美国国家卫生研究院;
关键词
Fungal infections; Cancer patients; Intensive Care Unit; CRITICALLY-ILL PATIENTS; CLINICAL-PRACTICE GUIDELINES; NON-ALBICANS CANDIDEMIA; D-GLUCAN ASSAY; AMPHOTERICIN-B; RISK-FACTORS; ANTIFUNGAL THERAPY; DISEASES SOCIETY; FLUCONAZOLE PROPHYLAXIS; BRONCHOALVEOLAR LAVAGE;
D O I
10.1016/j.ijantimicag.2011.11.017
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Invasive fungal infections (IFIs) have emerged as a major cause of morbidity and mortality amongst critically ill patients. Cancer patients admitted to the Intensive Care Unit (ICU) have multiple risk factors for IFIs. The vast majority of IFIs in the ICU are due to Candida spp. The incidence of invasive candidiasis (IC) has increased over recent decades, especially in the ICU. A shift in the distribution of Candida spp. from Candida albicans to non-albicans Candida spp. has been observed both in ICUs and oncology units in the last two decades. Timely diagnosis of IC remains a challenge despite the introduction of new microbiology techniques. Delayed initiation of antifungal therapy is associated with increased mortality. Therefore, prediction rules have been developed and validated prospectively in order to identify those ICU patients at high risk for IC and likely to benefit from early treatment. These rules, however, have not been validated in cancer patients. Similarly, major clinical studies on the efficacy of newer antifungals typically do not include cancer patients. Despite the introduction of more potent and less toxic antifungals, mortality from IFIs amongst cancer patients remains high. In recent years, aspergillosis and mucormycosis have also emerged as significant causes of morbidity and mortality amongst ICU patients with haematological cancer. (c) 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
引用
收藏
页码:464 / 471
页数:8
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