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Crit Care:疑似侵袭性念珠菌病患者基于(1,3)-β-D-葡聚糖的经验性抗真菌治疗

2020-09-15 MedSci原创 MedSci原创

在重症脓毒症患者中,入住ICU并伴有浸润性念珠菌病风险的患者,采用(1,3)-β-D-葡聚糖指导策略可以减少经验性抗真菌治疗的持续时间。但是,该策略的安全性需要在未来大型的多中心临床试验中进一步验证。

(1,3)-β-D-葡聚糖已在临床实践中被广泛用于侵袭性念珠菌感染诊断。然而,这种血清生物标志物具有指导抗微生物治疗的潜力,以减少对疑似浸润性念珠菌病的危重脓毒症患者接受经验性抗真菌治疗的时间。

近日,危重病医学领域权威杂志Critical Care上发表了一篇研究文章,这是一项在入住ICU的重症患者中进行的单中心、随机、开放标签的临床试验。所有出现侵袭性念珠菌感染危险因素并开始进行经验性抗真菌治疗的脓毒症患者被随机分配(比例为1:1)到如果(1,3)-β-D-葡聚糖阴性停止抗真菌治疗的(1,3)-β-D-葡聚糖组或根据临床规则继续进行抗真菌治疗的对照组。入组时以及治疗之后的14天内每48/72h测量血清(1,3)-β-D-葡聚糖水平。该研究的主要终点是入院后前30天的抗真菌治疗时间。

研究人员将108位患者随机分为(1,3)-β-D-葡聚糖组(n=53)和对照组(n=55)。(1,3)-β-D-葡聚糖组抗真菌治疗的中位[IQR]持续时间为2天[1–3],而对照组为10天[6–13]天(两组之间的绝对差异平均值为6.29天[95%CI为3.94–8.65],p<0.001)。(1,3)-β-D-葡聚糖组30天死亡率(28.3% vs. 比27.3%,p=0.92)、念珠菌病的总发生率(11.3% vs. 12.7%,p=0.94)、机械通气时间(p=0.97)和ICU停留时间(p=0.23)与对照组相似。

由此可见,在重症脓毒症患者中,入住ICU并伴有浸润性念珠菌病风险的患者,采用(1,3)-β-D-葡聚糖指导策略可以减少经验性抗真菌治疗的持续时间。但是,该策略的安全性需要在未来大型的多中心临床试验中进一步验证。

原始出处:

Gennaro De Pascale.et al.(1,3)-β-D-Glucan-based empirical antifungal interruption in suspected invasive candidiasis: a randomized trial.Critical Care.2020.https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03265-y

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    2020-10-04 amy0563
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    2020-09-17 zhaojie88
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    2020-09-17 sunyl07
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    2020-09-16 绝望的人没有故乡

    学习了

    0

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    2020-09-16 刘煜

    阅读谢谢分享谢谢

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1775757, encodeId=53751e75757b2, content=<a href='/topic/show?id=19e45556efa' target=_blank style='color:#2F92EE;'>#抗真菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55567, encryptionId=19e45556efa, topicName=抗真菌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=596c38798743, createdName=amy0563, createdTime=Sun Oct 04 00:42:19 CST 2020, time=2020-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1670621, encodeId=834816e0621b2, content=<a href='/topic/show?id=c0425209338' target=_blank style='color:#2F92EE;'>#念珠菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52093, encryptionId=c0425209338, topicName=念珠菌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3be826737448, createdName=tigerlr107, createdTime=Tue Jul 27 10:42:19 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805617, encodeId=12e7180561e5b, content=<a href='/topic/show?id=a47be8513ba' target=_blank style='color:#2F92EE;'>#经验性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78513, encryptionId=a47be8513ba, topicName=经验性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dcaa509, createdName=tsing_hit, createdTime=Mon Jul 26 17:42:19 CST 2021, time=2021-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1353804, encodeId=929a1353804fd, content=<a href='/topic/show?id=dddce266537' target=_blank style='color:#2F92EE;'>#真菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72665, encryptionId=dddce266537, topicName=真菌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Sep 17 03:42:19 CST 2020, time=2020-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366375, encodeId=3c0413663e543, content=<a href='/topic/show?id=186126998e2' target=_blank style='color:#2F92EE;'>#侵袭性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26998, encryptionId=186126998e2, topicName=侵袭性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1be8234, createdName=sunyl07, createdTime=Thu Sep 17 03:42:19 CST 2020, time=2020-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=885611, encodeId=10af88561175, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/03/27/9fdee81ba9771b6af046150adc14ee91.jpg, createdBy=54572576350, createdName=绝望的人没有故乡, createdTime=Wed Sep 16 07:48:37 CST 2020, time=2020-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=885606, encodeId=a91888560653, content=阅读谢谢分享谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Wed Sep 16 07:02:47 CST 2020, time=2020-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=885444, encodeId=d475885444db, content=学习了,涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=ms2000001051330459, createdTime=Tue Sep 15 12:48:42 CST 2020, time=2020-09-15, status=1, ipAttribution=)]
    2020-09-15 ms2000001051330459

    学习了,涨知识了!

    0

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