Multidisciplinary approach to the treatment of invasive fungal infections in adult patients. Prophylaxis, empirical, preemptive or targeted therapy, which is the best in the different hosts?

Abstract

Abstract:The high morbidity, mortality, and health care costs associated with invasive fungal infections, especially in the critical care setting and immunocompromised host, have made it an excellent target for prophylactic, empiric, and preemptive therapy interventions principally based on early identifi cation of risk factors. Early diagnosis and treatment are associated with a better prognosis. In the last years there have been important developments in antifungal pharmacotherapy. An approach to the new diagnosis tools in the clinical mycology laboratory and an analysis of the use new antifungal agents and its application in different clinical situations has been made. Furthermore, an attempt of developing a state of the art in each clinical scenario (critically ill, hematological, and solid organ transplant patients) has been performed, trying to choose the best strategy for each clinical situation (prophylaxis, pre-emptive, empirical, or targeted therapy). The high mortality rates in these settings make mandatory the application of early de-escalation therapy in critically ill patients with fungal infection. In addition, the possibility of antifungal combination therapy might be considered in solid organ transplant and hematological patients.

Itraconazole prophylaxis for invasive Aspergillus infection in lung transplantation

“…Different drugs are used throughout the world . Echinocandins, nebulized amphotericin B (AmB), oral voriconazole, or ITCZ, alone or in combinations, are included . The echinocandins may be potentially effective agents for prevention of IA, but their dosage form, intravenous injection, is not suitable after leaving the hospital.…”

Identification of pathogenic yeast species by polymerase chain reaction amplification of theRPS0gene intron fragment

“…A rapid and accurate diagnosis of an invasive fungal infection is critical for early and appropriate treatment because patient prognosis improves if diagnosis is established early in invasive fungal infection, and adequate antifungal treatment is initiated sooner (Karp et al 1991;Garey et al 2006). Although empirical antifungal therapy may be applied, it is toxic and costly, and may also increase the selection of resistant Candida species (Bougnoux et al 1999;Zaragoza et al 2008). Thus, an early and accurate diagnosis of an invasive fungal infection is a matter of utmost importance.…”

Criteria for the administration of systemic antimicotic therapy in surgical intensive care units (literature review)

“…Этот полиен связывается с эргостеролом клеточной мембраны, что приводит к нарушению ее целостности, утечке цитоплазмы и гибели грибковой клетки. К амфотерицину В чувствительны все виды грибов рода Candida (за исключением C. lusitaniae и C. guilliermondii), зигомицеты, аспергиллы и криптококки [27]. Резистентность к амфотерицину В развивается редко, однако в ряде случаев отмечают повышение минимальной ингибирующей концентрации (МИК) в отношении C. glabrata и C. krusei [28].…”

“…Флуконазол, в отличие от итраконазола и вориконазола, неактивен в отношении аспергилл. Зигомицеты также нечувствительны ко всем азолам, за исключением позаконазола [27]. Флуконазол является ингибитором цитохрома CYP3A4 и по этой причине обладает высоким потенциалом лекарственного взаимодействия, в особенности с иммуносупрессантами, такими как циклоспорин и такролимус.…”