Azole-resistant Aspergillus and Echinocandin-resistant Candida - What are the treatment options?

IF 2.3 Q3 INFECTIOUS DISEASES Current Fungal Infection Reports Pub Date : 2020-06-01 Epub Date: 2020-03-26 DOI:10.1007/s12281-020-00379-2

Alison R Novak, Mary E Bradley, Tyree H Kiser, Scott W Mueller

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引用次数: 8

Abstract

Purpose of review: This review summarizes current treatment options for echinocandin-resistant Candida spp. (ERC) and azole-resistant Aspergillus fumigatus (ARAF), emphasizing recent in vitro/in vivo data, clinical reports, and consensus statements.

Recent findings: Advances in ERC and ARAF treatment are limited to specific antifungal combinations and dose optimization but remain reliant on amphotericin products. Although novel antifungals may provide breakthroughs in the treatment of resistant fungi, these agents are not yet available. Early identification and appropriate treatment remain a paramount, albeit elusive, task.

Summary: When either ERC or ARAF are suspected or proven, amphotericin products remain the cornerstone of initial therapy. For ERC, azoles are de-escalation options for susceptible isolates in stable patients to avoid amphotericin toxicities. Although combination echinocandin with high-dose salvage posaconazole or isavuconazole may be attempted in ARAF, it requires careful consideration following patient stabilization. Future research defining optimal therapies and early identification of ERC and ARAF is of extreme importance.

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抗唑曲霉和抗棘白菌假丝酵母-有什么治疗选择?

综述目的:本综述总结了目前对棘白菌素耐药念珠菌(ERC)和耐唑烟曲霉(ARAF)的治疗方案，强调了最近的体外/体内数据、临床报告和共识声明。最近发现:ERC和ARAF治疗的进展仅限于特定的抗真菌组合和剂量优化，但仍然依赖于两性霉素产品。尽管新的抗真菌药物可能在治疗耐药真菌方面提供突破，但这些药物尚未可用。尽管难以捉摸，但早期识别和适当治疗仍然是一项至关重要的任务。摘要:当怀疑或证实ERC或ARAF时，两性霉素产品仍然是初始治疗的基础。对于ERC，唑类药物是稳定患者中敏感分离株的降级选择，以避免两性霉素毒性。尽管棘白菌素联合大剂量补救性泊沙康唑或异唑康唑可用于ARAF，但需要在患者稳定后慎重考虑。未来的研究确定最佳治疗方法和早期识别ERC和ARAF是非常重要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Fungal Infection Reports INFECTIOUS DISEASES-

CiteScore

3.10

自引率

7.10%

发文量

期刊介绍： This journal intends to provide clear, insightful, balanced contributions that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of fungal infections. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as advances in diagnosis, current and emerging management approaches, and genomics and pathogenesis. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. Commentaries from well-known figures in the field are also provided, and an international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research.