终末期肝病合并侵袭性真菌感染的治疗
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摘要
终末期肝病合并侵袭性真菌感染患者的病死率高。其临床表现常不典型,诊断上存在一定难度,且抗真菌药物存在诸如肝肾毒性、药物相互作用和耐药等临床问题,终末期肝病合并侵袭性真菌感染的治疗面临较大挑战。本文将主要围绕终末期肝病合并侵袭性真菌感染的治疗进行综述。
The patients with end-stage liver disease(ESLD) complicated with invasive fungal infection(IFI) have a high mortality. Atypical clinical manifestations, certain difficulties in the diagnosis, liver and kidney toxicity of anti-fungal agents, drug-drug interactions and drug resistance totally lead to a great challenge in clinical treatment of ESLD complicated with IFI. The present article summarizes the treatment of ESLD complicated with IFI.
The patients with end-stage liver disease(ESLD) complicated with invasive fungal infection(IFI) have a high mortality. Atypical clinical manifestations, certain difficulties in the diagnosis, liver and kidney toxicity of anti-fungal agents, drug-drug interactions and drug resistance totally lead to a great challenge in clinical treatment of ESLD complicated with IFI. The present article summarizes the treatment of ESLD complicated with IFI.
引文
[1]陈韬,宁琴.终末期肝病合并感染诊治专家共识[J].传染病信息,2018,31(4):568-578.
[2] Drgona L, Khachatryan A, Stephens J, et al. Clinical and economic burden of invasive fungal diseases in Europe:focus on pre-emptive and empirical treatment of Aspergillus and Candida species[J]. Eur J Clin Microbiol Infect Dis, 2014, 33(1):7-21.
[3] Hou Z, Tan D, Liu G, et al. Clinical characteristics and therapeutic analysis of invasive fungal infection in chronic severe hepatitis patients[J]. Zhong Nan Da Xue Xue Bao Yi Xue Ban, 2010, 35(6):537-542.
[4] Spernovasilis N, Kofteridis DP. Pre-existing liver disease and toxicity of antifungals[J]. J Fungi(Basel), 2018, 4(4):pii:e133.
[5] Mistry GC, Migoya E, Deutsch PJ, et al. Single-and multiple-dose administration of caspofungin in patients with hepatic insufficiency:implications for safety and dosing recommendations[J]. J Clin Pharmacol, 2007, 47(8):951-961.
[6]中华医学会重症医学分会.重症患者侵袭性真菌感染诊断与治疗指南(2007)[J].中华内科杂志,2007,46(11):960-966.
[7] Verma A, Auzinger G, Kantecki M, et al. Safety and efficacy of anidulafungin for fungal infection in patients with liver dysfunction or multiorgan failure[J]. Open Forum Infect Dis, 2017, 4(1):ofw241.
[8] Wells C, Lever AM. Dose-dependent fluconazole hepatotoxicity proven on biopsy and rechallenge[J]. J Infect, 1992, 24(1):111-112.
[9] Luong ML, Al-Dabbagh M, Groll AH, et al. Utility of voriconazole therapeutic drug monitoring:a meta-analysis[J]. J Antimicrob Chemother, 2016, 71(7):1786-1799.
[10] Lo Re V 3rd, Carbonari DM, Lewis JD, et al. Oral azole antifungal medications and risk of acute liver injury, overall and by chronic liver disease status[J]. Am J Med, 2016, 129(3):283-291.
[11] Cornely OA, Duarte RF, Haider S, et al. Phase 3 pharmacokinetics and safety study of a posaconazole tablet formulation in patients at risk for invasive fungal disease[J]. J Antimicrob Chemother, 2016, 71(3):718-726.
[12] Desai A, Schmitt-Hoffmann AH, Mujais S, et al. Population pharmacokinetics of isavuconazole in subjects with mild or moderate hepatic impairment[J]. Antimicrob Agents Chemother, 2016, 60(5):3025-3031.
[13] Desai AV, Kovanda LL, Hope WW, et al. Exposure-response relationships for isavuconazole in patients with invasive aspergillosis and other Filamentous fungi[J]. Antimicrob Agents Chemother, 2017, 61(12):pii:e01034-17.
[14] Folk A, Cotoraci C, Balta C, et al. Evaluation of hepatotoxicity with treatment doses of flucytosine and amphotericin B for invasive fungal infections[J]. Biomed Res Int, 2016, 2016:5398730.
[15] Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis:2016 update by the Infectious Diseases Society of America[J]. Clin Infect Dis, 2016, 62(4):e1-e50.
[16] Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis:2016 update by the Infectious Diseases Society of America[J]. Clin Infect Dis, 2016, 63(4):e1-e60.
[17] Cordonnier C, Pautas C, Maury S, et al. Empirical versus preemptive antifungal therapy for high-risk, febrile, neutropenic patients:a randomized, controlled trial[J]. Clin Infect Dis, 2009, 48(8):1042-1051.
[18]中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2018版)[J].现代医药卫生,2018,24(24):3897-3904.
[19] Alberino F, Gatta A, Amodio P, et al. Nutrition and survival in patients with liver cirrhosis[J]. Nutrition, 2001, 17(6):445-450.
[20] Plauth M, Bernal W, Dasarathy S, et al. ESPEN guideline on clinical nutrition in liver disease[J]. Clin Nutr, 2019, 38(2):485-521.
[21] Gravito-Soares M, Gravito-Soares E, Lopes S, et al. Spontaneous fungal peritonitis:a rare but severe complication of liver cirrhosis[J]. Eur J Gastroenterol Hepatol, 2017, 29(9):1010-1016.
[22] Fiore M, Leone S. Spontaneous fungal peritonitis:epidemiology, current evidence and future prospective[J]. World J Gastroenterol, 2016, 22(34):7742-7747.
[23] Matsubara VH, Bandara HM, Mayer MP, et al. Probiotics as antifungals in mucosal candidiasis[J]. Clin Infect Dis, 2016, 62(9):1143-1153.
[24] Hu HJ, Zhang GQ, Zhang Q, et al. Probiotics prevent candida colonization and invasive fungal sepsis in preterm neonates:a systematic review and meta-analysis of randomized controlled trials[J]. Pediatr Neonatol, 2017, 58(2):103-110.
[2] Drgona L, Khachatryan A, Stephens J, et al. Clinical and economic burden of invasive fungal diseases in Europe:focus on pre-emptive and empirical treatment of Aspergillus and Candida species[J]. Eur J Clin Microbiol Infect Dis, 2014, 33(1):7-21.
[3] Hou Z, Tan D, Liu G, et al. Clinical characteristics and therapeutic analysis of invasive fungal infection in chronic severe hepatitis patients[J]. Zhong Nan Da Xue Xue Bao Yi Xue Ban, 2010, 35(6):537-542.
[4] Spernovasilis N, Kofteridis DP. Pre-existing liver disease and toxicity of antifungals[J]. J Fungi(Basel), 2018, 4(4):pii:e133.
[5] Mistry GC, Migoya E, Deutsch PJ, et al. Single-and multiple-dose administration of caspofungin in patients with hepatic insufficiency:implications for safety and dosing recommendations[J]. J Clin Pharmacol, 2007, 47(8):951-961.
[6]中华医学会重症医学分会.重症患者侵袭性真菌感染诊断与治疗指南(2007)[J].中华内科杂志,2007,46(11):960-966.
[7] Verma A, Auzinger G, Kantecki M, et al. Safety and efficacy of anidulafungin for fungal infection in patients with liver dysfunction or multiorgan failure[J]. Open Forum Infect Dis, 2017, 4(1):ofw241.
[8] Wells C, Lever AM. Dose-dependent fluconazole hepatotoxicity proven on biopsy and rechallenge[J]. J Infect, 1992, 24(1):111-112.
[9] Luong ML, Al-Dabbagh M, Groll AH, et al. Utility of voriconazole therapeutic drug monitoring:a meta-analysis[J]. J Antimicrob Chemother, 2016, 71(7):1786-1799.
[10] Lo Re V 3rd, Carbonari DM, Lewis JD, et al. Oral azole antifungal medications and risk of acute liver injury, overall and by chronic liver disease status[J]. Am J Med, 2016, 129(3):283-291.
[11] Cornely OA, Duarte RF, Haider S, et al. Phase 3 pharmacokinetics and safety study of a posaconazole tablet formulation in patients at risk for invasive fungal disease[J]. J Antimicrob Chemother, 2016, 71(3):718-726.
[12] Desai A, Schmitt-Hoffmann AH, Mujais S, et al. Population pharmacokinetics of isavuconazole in subjects with mild or moderate hepatic impairment[J]. Antimicrob Agents Chemother, 2016, 60(5):3025-3031.
[13] Desai AV, Kovanda LL, Hope WW, et al. Exposure-response relationships for isavuconazole in patients with invasive aspergillosis and other Filamentous fungi[J]. Antimicrob Agents Chemother, 2017, 61(12):pii:e01034-17.
[14] Folk A, Cotoraci C, Balta C, et al. Evaluation of hepatotoxicity with treatment doses of flucytosine and amphotericin B for invasive fungal infections[J]. Biomed Res Int, 2016, 2016:5398730.
[15] Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis:2016 update by the Infectious Diseases Society of America[J]. Clin Infect Dis, 2016, 62(4):e1-e50.
[16] Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis:2016 update by the Infectious Diseases Society of America[J]. Clin Infect Dis, 2016, 63(4):e1-e60.
[17] Cordonnier C, Pautas C, Maury S, et al. Empirical versus preemptive antifungal therapy for high-risk, febrile, neutropenic patients:a randomized, controlled trial[J]. Clin Infect Dis, 2009, 48(8):1042-1051.
[18]中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2018版)[J].现代医药卫生,2018,24(24):3897-3904.
[19] Alberino F, Gatta A, Amodio P, et al. Nutrition and survival in patients with liver cirrhosis[J]. Nutrition, 2001, 17(6):445-450.
[20] Plauth M, Bernal W, Dasarathy S, et al. ESPEN guideline on clinical nutrition in liver disease[J]. Clin Nutr, 2019, 38(2):485-521.
[21] Gravito-Soares M, Gravito-Soares E, Lopes S, et al. Spontaneous fungal peritonitis:a rare but severe complication of liver cirrhosis[J]. Eur J Gastroenterol Hepatol, 2017, 29(9):1010-1016.
[22] Fiore M, Leone S. Spontaneous fungal peritonitis:epidemiology, current evidence and future prospective[J]. World J Gastroenterol, 2016, 22(34):7742-7747.
[23] Matsubara VH, Bandara HM, Mayer MP, et al. Probiotics as antifungals in mucosal candidiasis[J]. Clin Infect Dis, 2016, 62(9):1143-1153.
[24] Hu HJ, Zhang GQ, Zhang Q, et al. Probiotics prevent candida colonization and invasive fungal sepsis in preterm neonates:a systematic review and meta-analysis of randomized controlled trials[J]. Pediatr Neonatol, 2017, 58(2):103-110.