侵袭性念珠菌病的诊治进展

Advances in diagnosis and treatment of invasive candidiasis

侵袭性念珠菌病是指由念珠菌属病原菌引起的系统性真菌感染,是导致非免疫抑制状态的危重患者死亡的主要原因之一。近年来,非白色念珠菌所致的侵袭性念珠菌病有所增加,白色念珠菌所占比例有所降低,但仍是引起侵袭性念珠菌病最常见的病原菌。侵袭性念珠菌病的危险因素包括:应用广谱抗生素,念珠菌的黏膜定植,血管内导管植入,全胃肠外营养,胃肠道手术,中性粒细胞缺乏,肾功能衰竭行血液透析,应用免疫抑制剂等。念珠菌的定植强度与侵袭性感染有很强的相关性。由于临床表现无特异性,而且血培养阳性率低,侵袭性念珠菌病的诊断较为困难,常易误诊,导致治疗延误。侵袭性念珠菌病的预防和治疗方法主要包括靶向预防性用药、经验治疗、抢先治疗和确诊治疗。

Invasive candidiasis is a systematic infection caused by Candida species,and is one of the top causes leading to death of critically ill patients with nonimmune inhibitory state.Invasive candidiasis caused by genera other than Candida albicans is increasing in recent years.Candida albicans,however,accounting for less cases of invasive candidiasis than before,are still the most common pathogen leading to invasive candidiasis.Invasive candidiasis-related risk factors are as follows：use of broad-spectrum antibacterial agents,Candida mucosa colonization,indwelling vascular catheters,parenteral nutrition,gastrointestinal surgery,neutropenia,hemodialysis for renal failure,and the use of immunosuppressive agents.Colonization intensity of Candida is strongly correlated with the occurrence of invasive infection.The final diagnosis of invasive candidiasis is difficult due to lack of specificity in clinical manifestations and low positive rate of blood culture.Therefore,misdiagnosis is common and results in delay of treatment.The prophylaxis and treatment for invasive candidiasis mainly include targeted prophylactic medication,empirical therapy,preemptive therapy and proven therapy.