念珠菌病诊断与治疗-专家共识

2011320112ChinJInfectChemother,Mar2011,Vol11,No2:中华医学会念珠菌病诊治策略高峰论坛专家组:!;!;!;!:R379.4!!:C!!:10097708(2011)02008115ThediagnosisandtreatmentofCandidiasis:theexpertconsensusDraftedbyascientificworkinggroup.!:,Email:[e-mail];,Email:[e-mail]!!:201092650,:,,,(Candidaspecies),(invasivefungaldisease,IFD)[1],(BSI)BSI4,39.2%(ICU47.1%)[2],,,,,,,,,,,,,,,,,,10,IFDICUIFD42%[3],BSI9%[2]0.4/10[1],15%~25%,10%~15%[4]ICU12.7d15.5d,[5]812011320112ChinJInfectChemother,Mar2011,Vol11,No2ICUHIV[6],,41142ARTEMIS1997∀200710.570.9%62.9%~65.0%,[7],0.9%~1.4%ARTEMIS52001∀2005,61.5%,16.0%14.0%1.6%1.9%2.2%,17%5.6%6.8%82%,ARTEMIS[8]ICUICU,40%,23%15%9%[9]54%[10]65[11],,:#,;∃()!#;∃:;%:;&:;∋;(:;):;∗;+IFD,,IFD,/(EORTC/MSG)2002[12]2008EORTC/MSG[13]IFD3,(proven,)(probable,)(possible,),,,,IFD,,(proven)(probable),(possible),IFD2008EORTC/MSGIFD1.(proven)(1)!IFD,,,2.(probable)(2)!IFD(probable),1,CT,3.(possible)!2,4.!,,,,IFD(1),,822011320112ChinJInfectChemother,Mar2011,Vol11,No2(1)![14][1516],3:#1;∃,(),()[17];%;&2,,2();∋D(G)2(2)!,,,,(),,IFD,,:#1;∃,;%;&2,,2(3)!()1.!,(),,2.(VVC)!VVC,,,VVC,,VVC[17]3.!,,,[17]4.!,,,,,[1718]5.!,,,,[17]()!1.!#,(cost/effective)[19]1h:(yeast)(mould);(),,,∃:2.!,3.!G[19]G832011320112ChinJInfectChemother,Mar2011,Vol11,No24.!PCR,5.![20],[21],,[18](proven)(probable),;;()!()/(PK/PD),4:(B)1.B!B(AmBD)3(LFAmB),B(LAmB)B(ABLC)B(ABCD)AmBABCDAmBD,50,IFD,AmBDB(LFAmB)AmBD,[22],AmBDABCDLFAmBAmBD,0.5~0.7mg/kg,,1mg/kg[6]LFAmB3~5mg/kg[6,23]2.!,,,,(1)AmBD[2425],,(95%),,,,,,,[18],[18],50%,,[26][26],,,2(96%),[26]AmB,[27],[18][18],[18],,,[18]3.!,842011320112ChinJInfectChemother,Mar2011,Vol11,No2,33,15~30h,,(0~5%)2%[26],,4.!(),(80%),,,75%,90%[26],AmB,()1.!,(1)1!abBSSSSSSSSSSSSSSSSSSSSSRcSDDRSDDRSDDRSDDRSSISRSDDRSSIRSISSSSSSSRS!!aPappasPG,KauffmanCA,AndesD,etal.ClinInfectDis,2009,48:512bcI:;R:;S:;SDD:!!,,,,,,,2,,AmB,[28],[6,18],(MIC,64mg/L)[18]AmBMIC(creep),AmB,0.7mg/kg,1mg/kg[6],,,,2.!:#;∃;%;&,,,,B3.!,IFD[2930]:#,,[18],2:176.8mmol/L(2mg/dL),40u2d3d852011320112ChinJInfectChemother,Mar2011,Vol11,No2[31]∃%&ICU2009IDSA[18]:#200~400mg(3~6mg/kg)LFAmB1~2mg/kg7~14d,∃ICU,400mg(6mg/kg)%400mg(6mg/kg)200mg3()50mg200mg&,400mg(6mg/kg)200mg350mg4.!(,4),[25,32][18,3335],,(3)[18],[33],ICU[3435],IFD,/[36][37][38][3940][41][42]()(3)1.(1)!#:,,,(),,;,,,∃:AmBDLFmB(ABCD),,AmBDLFAmB%:800mg(12mg/kg),400mg(6mg/kg);70mg,50mg;200mg,100mg();100mg;AmBD0.5~1mg/kg;LFAmB3~5mg/kg;400mg(6mg/kg)2,200mg(3mg/kg)2,14d,1,,,,,[4344](2)!LFAmB,,,LFAmB;,LFAmBLFAmB,LFAmB,LFAmB,,,[18],,862011320112ChinJInfectChemother,Mar2011,Vol11,No22.(1)!(NVE)AmBD,AmBD,IDSA[18]LFAmBAmBD,,,6~8,(PVE)NVE,(2)!AmBDLFAmB,,(3)!(),23.!,(),,,G,(1)!,,LFAmBAmBD(2)!,,4d,,[18]LFAmBAmBD,LFAmBAmBD,:,,,[31]AmB,,4.(CNS)!CNS,,,,90%,,AmBD(0.7~1mg/kg)(25mg/kg,4)(400~800mg,6~12mg/kg)LFAmBAmBD[18],LFAmBAmBD,(3~5mg/kg)AmB,,AmBDLFAmB,AmB,CNS5.!,,,(),,AmBD(0.7~1mg/kg)(25mg/kg,4);800mg,12mg/kg,400~800mg(6~12mg/kg)AmBD+LFAmB(3~5mg/kg),(6mg/kg,121,3~4mg/kg,121)4~66.!,,,AIDS(400mg,6mg/kg),AmBD(0.5~1mg/kg)LFAmB(3~5mg/kg)2,872011320112ChinJInfectChemother,Mar2011,Vol11,No26~126,2,,7.!,,,,,,AmB1~2,,AmBAmBD(0.5~0.7mg/kg)LFAmB(3~5mg/kg),(400mg,6mg/kg),,8.!,()(1)!,,,,,(200~400mg,3~6mg/kg)AmBD(0.3~0.6mg/kg)(2)!,AmBD200mg(3mg/kg),2,,AmBD(0.3~0.6mg/kg)1~7d(25mg/kg,4),7~10dAmBD,(3)!(200~400mg,3~6mg/kg),2,AmBD(0.5~0.7mg/kg)(25mg/kg,4),2,,(4)!,,,AmBD(200~400mg,3~6mg/kg)AmBD(0.5~0.7mg/kg)(25mg/kg,4)9.!,,,(),,10.()!,AmBD(AmBD,2~4mg/L),[17],,[45],B,,[45]11.!,,,AmBD(1mg/kg)(12mg/kg)LFAmB(3~5mg/kg),/,,1000g,,882011320112ChinJInfectChemother,Mar2011,Vol11,No2()1.!,,;,1~2,2~4,,,AmBD0.5~1mg/kg,10~25mg/kg,[31]2.!,,,,(),,,,,,[46],,2009[18],,,3.!(4~6mL,4,10u/mL)(1~2,4,20u/),(10mg,5),(100~200mg,3mg/kg):200mg(400mg,2−3d,400mg−28d),(200mg2)AmBDAmBD(0.3mg/kg)4.!,200~400mg(3~6mg/kg),14~21d,400mg(6mg/kg),AmBD(0.3~0.7mg/kg),(200mg),(400mg,2),/(200mg,2),14~21dAmBD5.!6.VVC!VVC,VVC150mgVVC(1,4),10~14d,150mg,1,6[18,47]1!(proven)a(molds)b(yeasts)b:c,()c,e!,,((24h))!d()()():CSF!!aDePauwB,WalshTJ,DonnellyJP,etal.ClinInfectDis2008,46:1816(13),,(yeasts)bcGrocottGomorri,(PAS),,(,calcofluororblankophor)de892011320112ChinJInfectChemother,Mar2011,Vol11,No22!IFD(probable)a,bc!1.:0.5−109/L,10d,!2.!3.,0.3mg/kg3()!4.90dT,TNF(,alemtuzumab)!5.()d!1.e:CT31:!,,(halosign)!(aircrescentsign)!!2.:!3.:,1:!()!!,!4.,21:!!MRI()CT!5.f,2,21:!()()!!():!!,1:!!!!!!()!()g:!!:!!IFD,:D!!aDePauwB,WalshTJ,DonnellyJP,etal.ClinInfectDis,2008,46:1817(13),b(probable)11111,(possible)c,IFDTdef,g,(),3!a!![800mg(12mg/kg),400mg(6mg/kg)]b(A.)B(3~5mg/kg);B(0.5~1.0mg/kg);[2,400mg(6mg/kg),2,200mg(3mg/kg)](A.),14d902011320112ChinJInfectChemother,Mar2011,Vol11,No23()!!b,B(3~5mg/kg)(A/),[800mg(12mg/kg),400mg(6mg/kg)];[2,400mg(6mg/kg),2,200mg(3mg/kg))(B0)B,,,!!(B0)B(3~5mg/kg)B(0.5~1.0mg/kg)(B0)(),,()!!B(3~5mg/kg),(70mg,50mg)(A.),[2,400mg(6mg/kg),2,200mg(3mg/kg)](B.)[800mg(12mg/kg),400mg(6mg/kg)];[2,200mg(3mg/kg)](B.),4dCT!!,()(A0)11,[200~400mg(3~6mg/kg)]B(0.3~0.6mg/kg)!!,200mg(3mg/kg),2(A0)B0.3~0.6mg/kg,1~7d,4,25mg/kg,7~10d(B0),B()!200~400mg(3~6mg/kg),2(B0)B,0.5~0.7mg/kg,(4,25mg/kg);,2(B0