Эмпирическая терапия инвазивного кандидоза в отделениях реанимации и интенсивной терапии: современное состояние проблемы | КМАХ

Эмпирическая терапия инвазивного кандидоза в отделениях реанимации и интенсивной терапии: современное состояние проблемы

Клиническая Микробиология и Антимикробная Химиотерапия. 2011; 13(1):4-18

​ Веселов А.В.
Candida инвазивный кандидоз ОРИТ антимикотики эмпирическая терапия
Раздел
Болезни и возбудители
Тип
Журнальная статья
Публикация
Клиническая Микробиология и Антимикробная Химиотерапия. 2011; 13(1):4-18

Аннотация

Высокая распространённость инвазивного кандидоза (ИК) в условиях отделений реанимации и интенсивной терапии (ОРИТ) является одной из наиболее значимых проблем медицинской микологии и современной медицины в целом. Более 10% всех случаев инфекций в ОРИТ обусловлено грибами рода Candida. Инфекции, вызванные грибами рода Candida, связаны с высокими показателями смертности, в том числе и у пациентов в ОРИТ. Высокие показатели атрибутивной летальности и смена эпидемиологии возбудителей ИК требуют чёткого подхода со стороны клинициста в отношении выбора адекватных препаратов, прежде всего для эмпирической терапии. В настоящее время препараты выбора для эмпирической терапии ИК в ОРИТ ограничены эхинокандинами и азолами. Принимая во внимание важность использования стратегии деэскалационной терапии, эхинокандины в подавляющем большинстве случаев являются препаратами первой линии, учитывая их хороший профиль безопасности и сохраняющуюся высокую фунгицидную активность в отношении грибов рода Candida. В данном обзоре представлены основные подходы к выбору противогрибковых препаратов для эмпирической терапии инвазивного кандидоза у пациентов в ОРИТ.

  • 1. Zilberberg M.D., Shorr A.F. Fungal infections in the ICU. Infect Dis Clin North Am 2009; 23:625-42.
  • 2. Alberti C., Brun-Buisson C., Burchardi H., et al. Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med 2002; 28:108-21.
  • 3. Dimopoulos G., Piagnerelli M., Berré J., et al. Post mortem examination in the intensive care unit: still useful? Intensive Care Med 2004; 30:2080-5.
  • 4. Tortorano A.M., Caspani L., Rigoni A.L., et al. Candidosis in the intensive care unit: a 20-year survey. J Hosp Infect 2004; 57:8-13.
  • 5. Leleu G., Aegerter P., Guidet B., et al. Systemic candidiasis in intensive care units: a multicenter, matched-cohort study. J Crit Care 2002; 17:168-75.
  • 6. Almirante B., Rodríguez D., Park B.J., et al. Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, Barcelona, Spain, from 2002 to 2003. J Clin Microbiol 2005; 43:1829-35.
  • 7. Pfaller M.A., Diekema D.J., Gibbs D.L., et al. Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: 10.5-year analysis of susceptibilities of noncandidal yeast species to fluconazole and voriconazole determined by CLSI standardized disk diffusion testing. J Clin Microbiol 2009; 47:117-23.
  • 8. Pfaller M.A., Castanheira M., Messer S.A., et al. Variation in Candida spp. distribution and antifungal resistance rates among bloodstream infection isolates by patient age: report from the SENTRY Antimicrobial Surveillance Program (2008-2009). Diagn Microbiol Infect Dis 2010; 68:278-83.
  • 9. Dimopoulos G., Ntziora F., Rachiotis G., et al. Candida albicans versus non-albicans intensive care unit-acquired bloodstream infections: differences in risk factors and outcome. Anesth Analg 2008; 106:523-9.
  • 10. Arendrup M.C. Epidemiology of invasive candidiasis. Curr Opin Crit Care 2010; 16:445-52.
  • 11. Beck-Sague C., Jarvis W.R. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990: National Nosocomial Infections Surveillance System. J Infect Dis 1993; 167:1247-51.
  • 12. Marchetti O., Bille J., Fluckiger U., et al. Epidemiology of candidemia in Swiss tertiary care hospitals: secular trends, 1991-2000. Clin Infect Dis 2004; 38:311-20.
  • 13. Luzzati R., Allegranzi B., Antozzi L., et al. Secular trends in nosocomial candidaemia in non-neutropenic patients in an Italian tertiary hospital. Clin Microbiol Infect 2005; 11:908-13.
  • 14. Richards M.J., Edwards J.R., Culver D.H., et al. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000; 21:510-5.
  • 15. Wisplinghoff H., Bischoff T., Tallent S.M., et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39:309-17.
  • 16. Bouza E., Munoz P. Epidemiology of candidemia in intensive care units. Int J Antimicrob Agents 2008; 32(Suppl. 2):S87-91.
  • 17. Marriott D.J.E., Playford E.G., Chen S., et al. Determinants of mortality in non-neutropenic ICU patients with candidaemia. Crit Care 2009; 13:R115.
  • 18. Laupland K.B., Zygun D.A., Davies H.D., et al. Population based assessment of intensive care unit-acquired bloodstream infections in adults: incidence, risk factors, and associated mortality rate. Crit Care Med 2002; 30:2462-7.
  • 19. Blot S.I., Depuydt P., Annemans L., et al. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis 2005; 41:1591-8.
  • 20. Ostrosky-Zeichner L., Pappas P. Invasive candidasis in the intensive care unit. Crit Care Med 2006; 34:857-63.
  • 21. Bougnoux M-E., Kac G., Aegerter P., et al., CandiRea Study Group. Candidemia and candiduria in critically ill patients admitted to intensive care units in France: incidence, molecular diversity, management and outcome. Intensive Care Med 2008; 34:292-9.
  • 22. Eggimann P., Garbino J., Pittet D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis 2003; 3:685-702.
  • 23. Banerjee S.N., Emori T.G., Culver D.H., et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989: National Nosocomial Infections Surveillance System. Am J Med 1991; 91:86S9S.
  • 24. Asmundsdottir L.R., Erlendsdottir H., Gottfredsson M. Increasing incidence of candidemia: results from a 20- year nationwide study in Iceland. J Clin Microbiol 2002; 40:3489-92.
  • 25. Arendrup M.C., Fuursted K., Gahrn-Hansen B., et al. Seminational surveillance of fungaemia in Denmark 2004- 2006: increasing incidence of fungaemia and numbers of isolates with reduced azole susceptibility. Clin Microbiol Infect 2008; 14:487-94.
  • 26. Leroy O., Gangneux J.-P., Montravers P., et al. Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006). Crit Care Med 2009; 37:1612-8.
  • 27. Jorda-Marcos R., Alvarez-Lerma F., Jurado M., et al. Risk factors for candidemia in critically ill patients: a prospective surveillance study. Mycoses 2007; 50:302-10.
  • 28. Playford E.G., Marriott D., Nguyen Q., et al. Candidemia in nonneutropenic critically ill patients: risk factors for nonalbicans Candida spp. Crit Care Med 2008; 36:2034-9.
  • 29. Gleason T.G., May A.K., Caparelli D., et al. Emerging evidence of selection of fluconazole-tolerant fungi in surgical intensive care units. Arch Surg 1997; 132:1197- 201.
  • 30. Berrouane Y.F., Herwaldt L.A., Pfaller M.A. Trends in antifungal use and epidemiology of nosocomial yeast infections in a university hospital. J Clin Microbiol 1999; 37:531-7.
  • 31. Bassetti M., Ansaldi F., Nicolini L., et al. Incidence of candidemia and relationship with fluconazole use in an intensive care unit. J Antimicrob Chemother 2009; 64:625-9.
  • 32. Blot S., Janssens R., Claeys G., et al. Effect of fluconazole consumption on long-term trends in candidal ecology. J Antimicrob Chemother 2006; 58:474-7.
  • 33. Magill S.S., Swoboda S.M., Shields C.E., et al. The epidemiology of Candida colonization and invasive candidiasis in a surgical intensive care unit where fluconazole prophylaxis is utilized: follow-up to a randomized clinical trial. Ann Surg. 2009; 249:657-65.
  • 34. Dimopoulos G., Velegraki A., Falagas M.E. A 10-year survey of antifungal susceptibility of candidemia isolates from intensive care unit patients in Greece. Antimicrob Agents Chemother 2009; 53:1242-4.
  • 35. Pfaller M.A., Diekema D.J., Gibbs D.L., et al. Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: a 10.5-year analysis of susceptibilities of Candida species to fluconazole and voriconazole as determined by CLSI standardized disk diffusion. J Clin Microbiol 2010; 48:1366-77.
  • 36. Веселов А.В., Климко Н.Н., Кречикова О.И. и соавт. In vitro активность флуконазола и вориконазола в отношении более 10000 штаммов дрожжей: результаты 5летнего проспективного исследования ARTEMIS Disk в России. Клиническая Микробиология и Антимикробная Химиотерапия 2008; 10(4):34554.
  • 37. Lyon G.M., Karatela S., Sunay S., et al. Antifungal susceptibility testing of Candida isolates from the Candida surveillance study. J Clin Microbiol 2010; 48:1270-5.
  • 38. Pfaller M.A., Messer S.A., Boyken L., et al. Use of fluconazole as a surrogate marker to predict susceptibility and resistance to voriconazole among 13,338 clinical isolates of Candida spp. Tested by clinical and laboratory standards institute-recommended broth microdilution methods. J Clin Microbiol 2007; 45:70-5.
  • 39. НИИ антимикробной химиотерапии СГМА, 2010. Неопубликованные данные.
  • 40. Pfaller M.A., Diekema D.J., Andes D., et al. Clinical Breakpoints for the Echinocandins and Candida Revisited: Integration of Molecular, Clinical, and Microbiological Data to Arrive at Species-Specific Interpretive Criteria. CLSI 2010. Available from: http://www.clsi.org/Content/NavigationMenuCommittees/Microbiology/SCAntifungalSusceptibilityTes­ting/ January2010Antifungal Susceptibility MeetingPresentations/2a_CMRClinicalBreakpoints_Echinocandins AndCandida.pdf.
  • 41. Gracheva A., Kliasova G., Fedorova N., et al. In vitro activity of caspofungin against Candida spp. isolated from blood in hematological and ICU patients in Russia. Proceedings of 50th ICAAC, Boston, USA, 2010. M-385.
  • 42. Arnold T.M., Dotson E., Sarosi G.A., Hage C.A. Traditional and emerging antifungal therapies. Proc Am Thorac Soc 2010; 7:222-8.
  • 43. Sucher A.J., Chahine E.B., Balcer H.E. Echinocandins: the newest class of antifungals. Ann Pharmacother 2009; 43:1647-57.
  • 44. Ellis D. Amphotericin B: spectrum and resistance. J Antimicrob Chemother 2002; 49(Suppl 1):7-10.
  • 45. Kleinberg M. What is the current and future status of conventional amphotericin B? Int J Antimicrob Agents 2006; 27(Suppl 1):12-6.
  • 46. Meyer E., Schwab F., Gastmeier P., et al. Antifungal use in intensive care units. J Antimicrob Chemother 2007; 60:619-24.
  • 47. Phillips P., Shafran S., Garber G., et al. Multicenter randomized trial of fluconazole versus amphotericin B for treatment of candidemia in non-neutropenic patients: Canadian Candidemia Study Group. Eur J Clin Microbiol Infect Dis 1997; 16:337-45.
  • 48. Pfaller M.A., Diekema D.J. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev 2007; 20:133-63.
  • 49. Nivoix Y., Levêque D., Herbrecht R., et al. The enzymatic basis of drug-drug interactions with systemic triazole antifungals. Clin Pharmacokinet 2008; 47:779-92.
  • 50. Walsh T.J., Anaissie E.J., Denning D.W., et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2008; 46:327-60.
  • 51. Ostrosky-Zeichner L., Oude Lashof A.M., Kullberg B.J., Rex J.H. Voriconazole salvage treatment of invasive candidiasis. Eur J Clin Microbiol Infect Dis 2003; 22:651-5.
  • 52. Available from: http://www.pfizer.com/products/rx/rx_product_vfend.jsp.
  • 53. Hof H. A new, broad-spectrum azole antifungal: posaconazole – mechanisms of action and resistance, spectrum of activity. Mycoses 2006; 49(Suppl 1):2-6.
  • 54. Available from: http://www.noxafil.com.
  • 55. Bennett J.E. Echinocandins for candidemia in adults without neutropenia. N Engl J Med 2006; 355:1154-9.
  • 56. Sobel J.D., Revankar S.G. Echinocandins: first choice or first-line therapy for invasive candidiasis? N Engl J Med 2007; 356:2525-6.
  • 57. Mora-Duarte J., Betts R., Rotstein C., et al. Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med 2002; 347:2020-9.
  • 58. DiNubile M.J., Lupinacci R.J., Strohmaier K.M., et al. Invasive candidiasis treated in the intensive care unit: observations from a randomized clinical trial. J Crit Care 2007; 22:237-44.
  • 59. Pappas P.G., Rotstein C.M., Betts R.F., et al. Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis. Clin Infect Dis 2007; 45:883-93.
  • 60. Rüping M.J., Vehreschild J.J., Cornely O.A. Antifungal treatment strategies in high risk patients. Mycoses 2008; 51(Suppl 2):46-51.
  • 61. Playford E.G., Lipman J., Sorrell T.C. Prophylaxis, empirical and preemptive treatment of invasive candidiasis. Curr Opin Crit Care 2010; 16:470-4.
  • 62. Schuster M.G., Edwards Jr. J.E., Sobel J.D., et al. Empirical fluconazole versus placebo for intensive care unit patients: a randomized trial. Ann Intern Med 2008; 149:83-90.
  • 63. Lam S.W., Eschenauer G.A., Carver P.L. Evolving role of early antifungals in the adult intensive care unit. Crit Care Med 2009; 37:1580-93.
  • 64. Klevay M.J., Horn D.L., Neofytos D., et al. Initial treatment and outcome of Candida glabrata versus Candida albicans bloodstream infection. Diagn Microbiol Infect Dis 2009; 64:152-7.
  • 65. Labelle A.J., Micek S.T., Roubinian N., et al. Treatment related risk factors for hospital mortality in Candida bloodstream infections. Crit Care Med 2008; 36:2967- 72.
  • 66. Ibrahim E.H., Sherman G., Ward S., et al. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000; 118:146-55.
  • 67. Garnacho-Montero J., Garcia-Garmendia J.L., BarreroAlmodovar A., et al. Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 2003; 31:2742-51.
  • 68. Garey K.W., Rege M., Pai M.P., et al. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis 2006; 43:25-31.
  • 69. Morrell M., Fraser V., Kollef M.H. Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother 2005; 39:3640-5.
  • 70. Parkins M.D., Sabuda D.M., Elsayed S., Laupland K.B. Adequacy of empirical antifungal therapy and effect on outcome among patients with invasive Candida species infections. J Antimicrob Chemother 2007; 60:613-8.
  • 71. Kumar A., Roberts D., Wood K.E., et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006; 34:1589-96.
  • 72. Nolla-Salas J., Sitges-Serra A., León-Gil C., et al. Candidemia in non-neutropenic critically ill patients: analysis of prognostic factors and assessment of systemic antifungal therapy. Study Group of Fungal Infection in the ICU. Intensive Care Med 1997; 23:23-30.
  • 73. Baddley J.W., Patel M., Bhavnani S.M., et al. Association of fluconazole pharmacodynamics with mortality in patients with candidemia. Antimicrob Agents Chemother 2008; 52:3022-8.
  • 74. Rodriguez-Tudela J.L., Almirante B., Rodriguez-Pardo D., et al. Correlation of the MIC and dose/MIC ratio of fluconazole to the therapeutic response of patients with mucosal candidiasis and candidemia. Antimicrob Agents Chemother 2007; 51:3599-604.
  • 75. Zilberberg M.D., Kollef M.H., Arnold H., et al. Inappropriate empiric antifungal therapy for candidemia in the ICU and hospital resource utilization: a retrospective cohort study. BMC Infect Dis 2010; 10:150.
  • 76. Blumberg H.M., Jarvis W.R., Soucie J.M., et al. Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey. Clin Infect Dis 2001; 33:177-86.
  • 77. Ibanez-Nolla J., Nolla-Salas M., Leon M.A., et al. Early diagnosis of candidiasis in non-neutropenic critically ill patients. J Infect 2004; 48:181-92.
  • 78. Ostrosky-Zeichner L., Sable C., Sobel J., et al. Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting. Eur J Clin Microbiol Infect Dis 2007; 26:271-6.
  • 79. Leon C., Ruiz-Santana S., Saavedra P., et al. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med 2006; 34:730-7.
  • 80. Piarroux R., Grenouillet F., Balvay P., et al. Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients. Crit Care Med 2004; 32:2443-9.
  • 81. Playford E.G., Lipman J., Kabir M., et al. Assessment of clinical risk predictive rules for invasive candidiasis in a prospective multicentre cohort of ICU patients. Intensive Care Med 2009; 35:2141-5.
  • 82. Hollenbach E. To treat or not to treat: critically ill patients with candiduria. Mycoses 2008; 51(Suppl. 2):12-24.
  • 83. Delisle M.-S., Williamson D.R., Perreault M.M., et al. The clinical significance of Candida colonization of respiratory tract secretions in critically ill patients. J Crit Care 2008; 23:11-7.
  • 84. Troughton J.A., Browne G., McAuley D.F., et al. Prior colonization with Candida species fails to guide empirical therapy for candidaemia in critically ill adults. J Infect 2010; 61:403-9.
  • 85. Pappas P.G., Kauffman C.A., Andes D., et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:503-35.
  • 86. Thursky K.A., Playford E.G., Seymour J.F., et al. Recommendations for the treatment of established fungal infections. Intern Med J 2008; 38:496-520.
  • 87. Shorr A.F., Lazarus D.R., Sherner J.H., et al. Do clinical features allow for accurate prediction of fungal pathogenesis in bloodstream infections? Potential implications of the increasing prevalence of non-albicans candidemia. Crit Care Med 2007; 35:1077-83.
  • 88. Chow J.K., Golan Y., Ruthazer R., et al. Risk factors for albicans and non-albicans candidemia in the intensive care unit. Crit Care Med 2008; 36:1993-8.
  • 89. Lin M.Y., Carmeli Y., Zumsteg J., et al. Prior antimicrobial therapy and risk for hospital-acquired Candida glabrata and Candida krusei fungemia: a case-case-control study. Antimicrob Agents Chemother 2005; 49:4555-60.
  • 90. Lee I., Fishman N.O., Zaoutis T.E., et al. Risk factors for fluconazole-resistant Candida glabrata bloodstream infections. Arch Intern Med 2009; 169:379-83.
  • 91. Tumbarello M., Sanguinetti M., Trecarichi E.M., et al. Fungaemia caused by Candida glabrata with reduced susceptibility to fluconazole due to altered gene expression: risk factors, antifungal treatment and outcome. J Antimicrob Chemother 2008; 62:1379-85.
  • 92. Oude Lashof A., Donnelly J.P., Meis J., et al. Duration of antifungal treatment and development of delayed complications in patients with candidaemia. Eur J Clin Microbiol Infect Dis 2003; 22:43-8.
  • 93. Silva A., Costa-de-Oliveira S., Azevedo M., et al. The increase of chitin content in the cell wall accounts for the reduced echinocandin susceptibility displayed by clinical isolates of C. parapsilosis. Proceedings of the 20th ECCMID, Vienna, Austria, 2010; P831.
  • 94. Canton E., Espinel-Ingroff A., Pemán J., del Castillo L. In vitro fungicidal activities of echinocandins against Candida metapsilosis, C. orthopsilosis, and C. parapsilosis evaluated by time-kill studies. Antimicrob Agents Chemother 2010; 54:2194-7.
  • 95. Colombo A., Ngai A.L., Bourque M., et al. Caspofungin use in patients with invasive candidiasis caused by common non-albicans Candida species: review of the caspofungin database. Antimicrob Agents Chemother 2010; 54:1864-71.
  • 96. Horn D., Neofytos D., Anaissie E.J., et al. Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry. Clin Infect Dis 2009; 48:1695-703.
Просмотров
0 Аннотация
0 PDF
0 Цитирования
Поделились