卡泊芬净治疗高龄患者侵袭性真菌病29例临床分析

目的 观察卡泊芬净治疗高龄患者侵袭性真菌病(IFD)的疗效和安全性. 方法 回顾分析我院老年病房接受过卡泊芬净治疗的IFD患者的临床资料. 结果 2007年1月至2009年8月共有29例患者接受卡泊芬净治疗,且均为80岁以上高龄患者.除1例于用药当天死亡外,28例可评价疗效的患者中,痊愈13例(46.4%),显效6例(21.4%),进步3例(10.8%),无效6例(21.4%),总有效率为67.8%.13例痊愈者中,12例为念珠菌菌血症患者,1例为拟诊肺白念珠菌病患者.无效6例患者中,2例为念珠菌菌血症患者,1例为拟诊肺念珠菌病患者,3例为疑诊肺IFD患者.治疗过程中1例患者出现谷丙转氨酶升高,考虑为与用药有关的肝功能受损. 结论 卡泊芬净是治疗高龄患者侵袭性真菌病的安全有效药物.     

卡泊芬净治疗侵袭性真菌感染疗效观察

目的探讨卡泊芬净治疗侵袭性真菌感染（IFI）的疗效与安全性。方法对20例外科ICU IFI患者使用卡泊芬净50mg／d,观察临床疗效与不良反应。结果IFI痊愈8例,显效6例,进步4例,无效2例,有效率为70％,未出现严重不良反应。结论卡泊芬净治疗IFI患者疗效确切,不良反应小。     

肾移植术后并发卡氏肺孢子菌肺炎的治疗方案选择

摘要 目的：探讨肾移植术后并发卡氏肺孢子菌肺炎（PCP）患者用卡泊芬净治疗PCP感染的疗效。方法：将125例肾移植后并发PCP患者分为磺胺组（42例）、卡泊芬净组（37例）和磺胺+卡泊芬净组（46例），比较3组临床特征，分析各组治疗后患者体温恢复正常时间、卡氏肺孢子菌（PC）核酸转阴时间和治疗结局。结果：治疗前，3组患者年龄、性别、发热症状及实验室检测（G实验和乳酸脱氢酶）方面比较，差异无明显统计学意义（P均>0.05）。治疗后，磺胺组、卡泊芬净组、磺胺+卡泊芬净组体温恢复正常时间分别为（7.9±1.4）d，(8.1±1.7)d和(7.7±1.5)d，组间比较，差异无明显统计学意义（P>0.05）；PC核酸转阴时间分别为（13.4±1.6）d、（16.3±2.9）d、（13.9±2.5）d；卡泊芬净组PC核酸转阴时间明显长于磺胺组、磺胺+卡泊芬净组（P均<0.05），磺胺组和磺胺+卡泊芬净组比较，差异无明显统计学意义（P>0.05）；3组间的治疗结局比较，差异无明显统计学意义（P均>0.05）。结论：卡泊芬净单药治疗PCP能获得肯定的疗效，包括体温恢复正常、PC核酸转阴和治愈出院。卡泊芬净对于肾移植术后PCP患者的治疗是一个较好的选择。     

卡泊芬净治疗恶性血液病并发侵袭性真菌感染患者的疗效观察

恶性血液病患者因接受大剂量化疗,应用免疫抑制剂及广谱强效抗生素,造成中性粒细胞严重减少,免疫功能明显下降,极易发生侵袭性真菌感染(IFI)。抗真菌治疗疗程长,而多数并发真菌感染者的基础疾病重,对药物耐受性差,老年患者更为突出。我院采用卡泊芬净治疗恶性血液病并发IFI患者41例,观察其疗效和安全性,报告如下。     

卡泊芬净联合复方磺胺甲嗯唑治疗重症肺孢子菌肺炎

目的 探讨卡泊芬净联合复方磺胺甲嗯唑治疗重症肺孢子菌肺炎的疗效.方法 分析总结6例肺孢子菌肺炎患者的临床特点和诊治经过.结果 6例患者均接受卡泊芬净联合复方磺胺甲噁唑治疗,除1例放弃治疗外,其余5例均收到满意疗效.其中3例患者初始单用复方磺胺甲噁唑治疗,病情无好转,后改为联合卡泊芬净,病情得到控制.结论 卡泊芬净联合复方磺胺甲噁唑治疗肺孢子菌肺炎取得了满意疗效,值得推荐作为单用复方磺胺甲噁唑不能控制的肺孢子菌肺炎的治疗选择.     

卡泊芬净治疗危重病难治性侵袭性真菌感染临床研究

目的 评价卡泊芬净治疗氟康唑治疗无效的危重病侵袭性真菌感染患者的疗效和安全性.方法 采用开放性临床研究,对2005年5月至2007年6月浙江省人民医院ICU住院患者氟康唑治疗无效的44例侵袭性真菌感染患者,给予卡泊芬净首日负荷剂量70 mg,之后以50 mg/d维持治疗,疗程为10～40 d.结果 42例可评价患者中,痊愈18例(42.86%),显效14例(33.33%),总有效率76.19%,真菌清除率为62.22%.不良反应少,所有患者均耐受治疗.结论 卡泊芬净治疗危重病患者难治性侵袭性真菌感染安全、有效.     

侵袭性真菌感染经验治疗探讨

目前对临床医生而言,治疗侵袭性真菌感染(IFI)的最大困难就是明确诊断.而IFI延误治疗常导致患者死亡,因此.经验治疗显得尤其重要.选择经验治疗药物,需要综合考虑药物价值/效能比及患者的具体情况,推荐药物包括伊曲康唑、两性霉素B、伏立康唑和卡泊芬净及米卡芬净.但经验治疗尚存在很多问题.如何做到有科学依据的治疗是值得研究者们认真思考和深入探索的.     

卡泊芬净治疗老年人危重病侵袭性真菌感染的临床研究

侵袭性真菌感染(IFI)发生率日益增加,已成为危及重症监护病房(ICU)危重病患者生命的主要危险因素之一[1-2].卡泊芬净,为一种新型的棘白霉素类抗真菌药,抗菌谱广,不良反应少,但其在老年危重病患者真菌感染的疗效及安全性方面报道很少.我们应用卡泊芬净治疗40例老年危重病IFI患者,旨在了解其疗效及安全性.     

隐球菌临床及环境分离株对卡泊芬净与特比萘芬的体外联合药敏试验

目的　了解隐球菌临床及环境分离株对卡泊芬净与特比萘芬的体外联合抗菌活性。方法　采用美国国家实验室标准委员会 (NCCLS)M 2 7 A方案推荐的酵母菌微量稀释法及其微量稀释棋盘法 ,检测 78株新生隐球菌临床和环境分离株对卡泊芬净与特比萘芬的体外抗菌活性及其联合抗菌活性。结果　卡泊芬净和特比萘芬对新生隐球菌最小抑菌浓度 (MIC)值范围分别是 0 .2 5～ 32 μg/ml、2～16 μg/ml;几何均数分别是 32 μg/ml、8μg/ml。联合药敏试验结果显示 ,两者联合后对其中 5 %菌株有协同作用 ,4 2 %菌株有累加作用及 5 3%菌株有无关作用 ,任何菌株均无拮抗作用。同时卡泊芬净的MIC几何均数由 2 6 .8μg/ml降至 2 0 .6 μg/ml(P <0 .0 0 0 1) ,特比萘芬的MIC几何均数由7.9μg/ml降至 1.3μg/ml(P <0 .0 0 0 1)。此外 ,有 4株菌株对卡泊芬净药物敏感 ,其MIC分别是 2 μg/ml、2 μg/ml、0 .5 μg/ml、0 .2 5 μg/ml。 结论　卡泊芬净与特比萘芬的体外联合药敏试验表明 ,两者联合应用对新生隐球菌具有较好的体外抗菌活性     

继发性肺部念珠菌感染47例治疗分析

目的 探讨继发性肺部念珠茵感染的诊断和治疗相关问题.方法 收集2004-09-01-2006-08-31广东省人民医院呼吸内科47例住院患者,其中男24例,女23例.年龄(57.0±16.1)岁.均有住院时间较长、发热、有肺部感染性病变、普通抗感染治疗无效、呼吸道分泌物找到念珠茵并经抗真茵治疗有效,对其临床诊治情况进行分析.体温平均(38.4±0.6)℃,发热时间均超过6 d.发现真茵时的住院天数为(17.7±5.2)d,全部病例均有基础疾病.结果 病例的病原体包括:白色念珠茵38株,光滑念珠菌5株,克柔念殊菌2株,热带念珠菌1株,葡萄牙念珠菌1株.使用氟康唑进行治疗的28例患者,1例白色念珠菌和1例光滑念珠菌治疗无效,改用伏立康唑后治疗成功.使用伊曲康唑进行治疗的9例患者,有1例白色念珠菌和1例光滑念珠菌治疗无效,改用伏立康唑后治疗有效.使用伏立康唑进行治疗的7例全部有效,包括3例光滑念珠茵、1例葡萄牙念珠菌和3例白色念珠菌.7例使用卡泊芬净进行治疗的全部有效,本研究该药物抗真茵治疗覆盖了3例光滑念珠菌、2例克柔念珠菌、1例热带念珠菌和1例白色念珠菌.结论 本组继发性肺部念珠菌感染以白色念珠菌为主,全部患者均有发热.目前使用的新一代抗真菌药物伏立康唑、卡泊芬净均有可靠的疗效,其中卡泊芬净具有更好的安全性和耐受性.     

Caspofungin for post solid organ transplant invasive fungal disease: results of a retrospective observational study

M. Winkler, J. Pratschke, U. Schulz, S. Zheng, M. Zhang, W. Li, M. Lu, D. Sgarabotto, G. Sganga, P. Kaskel, S. Chandwani, L. Ma, J. Petrovic, M. Shivaprakash. Caspofungin for post solid organ transplant invasive fungal disease: results of a retrospective observational study.
Transpl Infect Dis 2010: 12: 230–237. All rights reserved Objective. This study was designed to determine clinical outcomes with caspofungin in patients with proven or probable invasive fungal infection (IFI) after a solid organ transplant (SOT) procedure. Methods. In this retrospective observational study, data were collected for a single episode of IFI in patients with an SOT between January 2004 and June 2007. Response was determined by the investigator as favorable (complete or partial) or unfavorable (stable disease or failure) at the end of caspofungin therapy (EOCT). The primary effectiveness population was the proportion of patients who received ≥5 doses of caspofungin (modified all‐patients‐treated population). Safety was assessed for patients who received ≥1 dose of caspofungin. Results. A total 81 of patients from 13 sites in China, Germany, Italy, and the United Kingdom were enrolled, including 49 (60%) liver, 22 (27%) heart, 5 (6%) lung, 2 (2%) kidney, 2 (2%) liver and kidney, and 1 (1%) pancreas and kidney recipients. Candidiasis was diagnosed in 64/81 patients (79%) and aspergillosis in 22/81 patients (27%). Most patients received caspofungin monotherapy (75%). Caspofungin was given as first‐line therapy to 59 (73%) patients. The overall favorable response at EOCT was 87% (58/67; 95% confidence interval [CI]: 76%, 94%), with favorable responses in 88% (43/49; 95% CI: 75%, 95%) of patients receiving caspofungin monotherapy and 83% (15/18; 95% CI: 59%, 96%) of patients receiving combination therapy with caspofungin (modified all‐patients‐treated population). Response by type of SOT was as follows: liver 87% (39/45), heart 93% (14/15), kidney 100% (5/5), and lung 50% (2/4). An overall survival rate (all‐patients‐treated) of 69% (56/81; 95% CI: 59%, 79%) was observed at 7 days post EOCT. No serious drug‐related adverse events were reported. Conclusion. In this study, caspofungin was effective and well tolerated in the treatment of IFIs involving SOT recipients.     

Antifungal therapy in patients with hematological malignancies: how to avoid overtreatment?

Historically, treatment of invasive fungal infections (IFI) has consisted of amphotericin B. However, new therapeutic agents have recently been introduced. At the same time, the relatively low incidence of IFI and the progress in the diagnostic accuracy of IFI have made routine use of empirical antifungal therapy questionable. OBJECTIVES AND METHODS: With the aim to define the present trends in the use of antifungal agents for the treatment of IFI, we prospectively observed type, safety, and efficacy of given antifungal treatment in patients with hematological malignancies during a recent 18-month period. We also analyzed the impact of restricted use of empirical antifungal therapy on IFI-related mortality. RESULTS: A total of 279 episodes of neutropenia and fever following the chemotherapy were recorded. Treatment of IFI was given during the management of 41 (14%) episodes. Voriconazole (27 episodes) and caspofungin (14 episodes) were the only antifungal agents used as initial therapy. The rate of antifungal therapy success outcome was 78%. The overall 4-week mortality rate was 8%. Two patients died of invasive pulmonary aspergillosis. Empirical antifungal therapy was given in 13 episodes with persistent febrile neutropenia (PFN) and resulted in successful outcome in 92% of cases. In general, antifungal agents were well tolerated and only two patients had to discontinue treatment because of severe adverse event. In 127 episodes of PFN, antifungal therapy was deemed unnecessary and accordingly was not administered. In this subgroup of patients, no IFI-related mortality occurred. CONCLUSION: A better tolerability and efficacy of voriconazole and caspofungin together with the availability of an oral formulation of voriconazole most probably contributed to the observed shift in the use of antifungal agents. A restricted use of empirical antifungal therapy was, in this setting, not associated with an increased IFI-related mortality.     

伊曲康唑治疗老年慢性肺部疾病合并肺部急性侵袭性真菌感染的临床疗效及心脏安全性

目的 观察伊曲康唑注射液治疗老年慢性肺部疾病者肺部急性侵袭性真菌感染(IFI)的临床效果与心脏安全性.方法 单中心、开放试验设计.选择70岁以上慢性肺部疾病基础上发生肺部In的患者,静脉应用伊曲康唑注射液治疗,观察用药14 d的临床有效性和心脏安全性.结果 35例患者纳入本研究,确诊3例,临床诊断32例;合并冠心病26例,肺心病20例,同时合并冠心病和肺心病17例.治疗14 d后,体温于7 d内降至正常的22例,11 d降至正常的3l例;14 d后血1,3-13.D葡聚糖水平降至正常的26例(78.79%);5例病原学为白念珠菌者x线胸片示原有病灶完全吸收.2例患者分别于治疗第4天、第5天出现左心功能不全表现伴室性心律失常,对症处理后均于次Et心力衰竭症状完全消失.治疗前后血B型利钠肽(BNP)水平在正常范围的例数比较差异有统计学意义(P<0.01).结论 伊曲康唑注射液治疗老年慢性肺部疾病基础上发生的肺部IFI 14 d临床有效率为78.79%;即使合并冠心病、肺心病的老年慢性肺部疾病患者应用该药14 d内也是比较安全的.     

Sudden unexpected death in children with a previously diagnosed cardiovascular disorder

BACKGROUND: It is known that children with previously diagnosed heart defects die suddenly. The causes of death are often unknown. OBJECTIVE: The aim of the study was to identify all infants and children within the Netherlands with previously diagnosed heart disease who had a sudden unexpected death (SUD), and to identify the possible cause of death. DESIGN: Retrospective, cross-sectional study. PATIENTS AND SETTING: All children (<19 years) with a previously diagnosed heart defect and SUD between January 1990 and June 2001 in seven out of eight tertiary centres in the Netherlands were identified using the hospital databases. We excluded patients receiving compassionate care. Diagnoses, clinical status and circumstances of death were sought from case notes and post mortem reports. Deaths were classified as of cardiac or non-cardiac origin. RESULTS: We identified 150 cases of SUD (89 male) at a median age of 2.3 years (range 18 days-18.9 years); 49/150 patients (33%) were 相似文献   

A prospective, randomized study of empirical antifungal therapy for the treatment of chemotherapy-induced febrile neutropenia in children

Given that the rationale for empirical antifungal therapy in neutropenic children is limited and based on adult patient data, we performed a prospective, randomized, controlled trial that evaluated 110 neutropenic children with persistent fever. Those at high risk for invasive fungal infections (IFI) received caspofungin (Arm C) or liposomal amphotericinB (Arm B); those with a lower risk were randomized to receive Arm B, C, or no antifungal treatment (Arm A). Complete response to empirical antifungal therapy was achieved in 90/104 patients (86·5%): 48/56 at high risk (85·7%) [88·0% in Arm B; 83·9% in Arm C (P = 0·72)], and 42/48 at low risk (87·5%) [87·5% in control Arm A, 80·0% Arm B, 94·1% Arm C; (P = 0·41)]. None of the variables tested by multiple logistic regression analysis showed a significant effect on the probability to achieve complete response. IFI was diagnosed in nine patients (8·2%, 95% confidence interval, 3·8-15·0). This randomized controlled study showed that empirical antifungal therapy was of no advantage in terms of survival without fever and IFI in patients aged <18 years and defined with low risk of IFI. Higher risk patients, including those with relapsed cancer, appear to be the target for empirical antifungal therapy during protracted febrile neutropenia.     

先天性心脏病介入治疗并发症分析

目的 探讨先天性心脏病(先心病)介入治疗中和治疗后并发症的发生率、原因及防治措施.方法 自1986年4月至2009年4月,阜外心血管病医院共有6029例先心病施行了介入治疗,对介入治疗中和治疗后发生的388例并发症和5例死亡的患者作回顾性分析.将遗留严重功能障碍及需要经介入或外科手术处理的并发症定为严重并发症,将患者离开导管室后发生的严重并发症定为迟发.结果 6029例先心病患者介入术中及术后并发症总发生率为6.44%,其中房间隔缺损(ASD)组的并发症为7.69%(184/2392);动脉导管未闭(PDA)组为4.20%(87/2070);肺动脉瓣球囊成形术组为1.31%(10/761);室间隔缺损组为14.94%(85/569);体肺侧支栓塞术组为3.13%(3/96);肺动静脉畸形栓塞术组为30.95%(13/42);冠状动脉瘘栓塞术组为12.50%(2/16);主动脉窦瘤破裂封堵术组为20.00%(2/10);主动脉瓣球囊成形术组为66.67%(2/3).6029例中严重并发症发生率为0.65%,其中迟发的严重并发症发生率为0.22%.总病死率为0.08%,其中肺动脉瓣球囊成形术组为0.26%(2/761),PDA封堵术组为0.05(1/2070),房间隔造口术组为9.10%(1/11),主动脉瓣球囊成形术组为33.33%(1/3).紧急手术占0.22%(13/6029),择期手术占0.13%(8/6029),安装永久起搏器占0.03%(2/6029),其余并发症均经保守治疗或介入处理.结论 先心病介入治疗的严重并发症及病死率低,术前应与患者及其亲属进行充分沟通,术后应作严格随访,尤其警惕部分介入治疗术后迟发并发症的发生.     

高龄肺癌住院患者感染真菌性肺炎的调查研究

目的 探讨高龄肺癌患者肺部真菌感染发病的特征.方法 总结住院继发真菌性肺炎患者64例的临床资料.结果 64例患者痰培养的致病真菌以白色假丝酵母菌为主.患者均用过抗生素治疗,痊愈39.1%（25例）,好转42.2%（27例）,好转治愈率为81.3%（52例）;病死率为18.8%（12例）,死亡原因以呼吸衰竭为主.本组临床资料示应用卡泊芬净治疗结束后肝肾功能无明显变化.结论 支气管、肺泡及医院真菌感染的高发生率是老年重症肺炎形成的重要因素.     

多发性骨髓瘤合并侵袭性真菌感染的临床特点及易感因素分析

目的 了解多发性骨髓瘤(MM)患者合并侵袭性真菌感染(IFI)的临床特点及易感因素.方法 回顾357例在我院住院诊治的MM患者,记录是否合并 IFI、一般临床资料、并发病、抗真菌治疗以及疗效和毒副作用.结果 44例(12.3%)患者在治疗过程中曾发生IFI,其中3例(6.8%)为确诊病例,8例(18.1%)为临床诊断,33例(75.0%)为拟诊.44例患者中,10例(22.7%)处于诱导化疗时出现真菌感染;4例(9.1%)为平台期;27例(61.4%)处于疾病进展状态;3例(6.8%)在行自体造血干细胞移植的过程中发生真菌感染.感染部位以肺部最常见,占50.O%.两性霉素B、伏立康唑、伊曲康唑、卡泊芬净、氟康唑的有效率分别为83.3%、75.O%、78.9%、75.O%和57.1%.各种抗真菌药物之间疗效比较差异无统计学意义(P=0.493).根据多因素分析,合并糖尿病(P=0.035,OR 2.527,95%CI 1.005～6.052),接受透析治疗(P=0.022,OR 2.768,95%CI 1.161～6.600)、粒细胞缺乏持续时间超过1周(P:0.019,OR 3.215,95%CI 1.200～7.407),之前是否使用广谱抗生素治疗(P=0.009,OR 3.350,95%CI 1.353～8.295),是否使用氟达拉滨(P=0.001,OR 4.669,95%CI1.813-12.023)差异有统计学意义.结论 MM患者是侵袭性真菌感染的高危人群,肺部是其最常见的感染部位,4种抗真菌药的疗效相当,合并糖尿病、化疗同时接受透析治疗、长时间粒细胞缺乏、广谱抗生素的应用、以及含有氟达拉滨的治疗是MM合并IFI的易感因素.     

Candidaemia in allogeneic stem cell transplant recipients: low risk without fluconazole prophylaxis

Invasive fungal infections (IFI) are common in allogeneic SCT recipients. We have reviewed our experience of IFI with special reference to candidaemia in 685 adult patients transplanted in 1983-2002. The donor was a matched sibling in 505 patients and an unrelated donor in 180 patients. A BM graft was used in 561 patients and a PB graft in 124 patients. Fluconazole prophylaxis was not used during the study period. Definite or probable IFI was observed in 60 patients (8.7%) with a dominance of Aspergillus infections (46 patients, incidence 6.7%). Candidaemia was found only in nine patients (1.3%). The causative agents were Candida albicans (n=8), C. krusei (n=2), and C. glabrata (n=1); in two patients, two causative agents were found. The median time to the diagnosis of candidaemia was 53 days (range 6-249 days) post transplant. Seven patients were neutropaenic at diagnosis, and four patients had experienced acute GVHD. All patients received antifungal therapy, but only one patient was cured. According to this study, candidaemia was a rare event in allogeneic SCT recipients. Thus, systematic prophylaxis against Candida infections might not be indicated. The prognosis of established infections is still poor due to comorbid conditions, notably GVHD.