Грибковые инфекции (к.м.н., доцент Ю.Л.Горбич)

29.08.2015
,
.
…
:
200
Candida spp.
.
(69,8%)…
,
201
.
201
.
…
.parapsilosis ,
1/3
,
…
1
29.08.2015
,
C.Lass-Flöerl,
(
)
2
29.08.2015
:
,
–
:
in vitro
3
29.08.2015
vs.
:
14
,
–
-
4
29.08.2015
:
in vitro
5
29.08.2015
1
2
- 300
- 300
)
,
.
,
Candida spp.
Aspergillus spp.
.
:
1,3- -D-
,
1,3- -D-
6
29.08.2015
:
in vitro
7
29.08.2015
:
ECDC
8
29.08.2015
Candida spp.
> 150
Candida,
5–
9
29.08.2015
:
Candida spp.:
10
29.08.2015
:
,
•
:
,
,
,
,
(?)
,
•
,
100 000
:
:
11
29.08.2015
12
29.08.2015
:
in vitro
13
29.08.2015
p < 0.001
p = 0.018 (>12 h vs. <12 h)
,
,
(
)
(
)
Morrell M et al. Antimicrob Agents Chemother 2005; 49:3640-45. Kumar A et al. ICAAC 2007; poster K-2174.
14
29.08.2015
?
1
+
2
+
3
J. Mensa et al. Treatment of critically ill patients with candidemia. International Journal of Antimicrobial Agents. 32 Suppl. 2 (2008) S93–S97.
15
29.08.2015
Candida
C.glabrata
C.krusei?
?
,
B.E. de Pauw, J.J. Picazo Present situation in the treatment of invasive fungal infection. / International Journal of Antimicrobial Agents 32 Suppl. 2 (2008) S167–S171
/
,%
?
1.
Shorr AF et al. Poster #899 at Society of Critical Care Medicine 37th Annual Congress. 2–6 Feb. 2008, Honolulu, Hawaii.
2.
Reboli AC et al. N Engl J Med 2007; 356: 2472-2482.
16
29.08.2015
17
29.08.2015
:
18
29.08.2015
19
29.08.2015
:
in vitro
20
29.08.2015
IV
APACHE II (
1
)
(
1
)
7
(1
+1
•
):
:
•
:
7
,
)
7
Segal BH et al. Defining responses to therapy and study outcomes in Clinical trials of invasive fungal diseases: mycoses study Group and European organization for research and
Treatment of cancer consensus criteria. Clinical Infectious Diseases 2008; 47:674–83.
Paphitou NI, Ostrosky-Zeichner L, Rex JH. Rules for identifying patients at increased risk for candidal infections in the surgical intensive care unit: approach to developing practical
criteria for systematic use in antifungal prophylaxis trials. Med Mycol. 2005;43(3):235-43.
21
29.08.2015
22
29.08.2015
:
in vitro
23
29.08.2015
vs.
,
(90-
)
,
,
+
24
29.08.2015
VOR-S Aspergillus fumigatus
VOR-R Aspergillus fumigatus
25
29.08.2015
:
:
26
29.08.2015
:
,
,
:
in vitro
27
29.08.2015
:
:
(
)
in vitro
400
• «
spp.
•
»
2
,
Mucor
28
29.08.2015
:
:
41
+
– 100%
– 45%
(6
)
29
29.08.2015
Trichosporon spp.
• T.asahii, T.asteroides, T.cutaneum, T.inkin, T.mucoides,
T.ovoides
,
,
,
Cryptococcus neoformans
,
,
Geotrichum, Hansenula, Malasseizia, Saccharomyces
Miceli et al. Lancet Infect Dis 2011
…
: Cryptococcus adeliensis, Cryptococcus
albidus, Cryptococcus curvatus, Cryptococcus flavescens, Cryptococcus laurentii Cryptococcus
uniguttulatus (
Filobasidium uniguttulatum), Malassezia furfur, Malassezia globosa,
Malassezia pachydermatis and Malassezia restricta, Pseudozyma spp., Rhodotorula glutinis, Rhodotorula
minuta and Rhodotorula mucilaginosa, Sporobolomyces spp., Trichosporon asahii, Trichosporon asteroides,
Trichosporon dermatis, Trichosporon inkin, Trichosporon jirovecii, Trichosporon loubieri, Trichosporon
mucoides and Trichosporon mycotoxinivorans
: Geotrichum candidum, Kodamaea ohmeri,
Saccharomyces cerevisiae (
. S. boulardii) and Saprochaete capitatae (Magnusiomyces
(Blastoschizomyces) capitatus
Trichosporon capitatum
Geotrichum (Dipodascus) capitatum) and
Saprochaete clavata.
30
29.08.2015
:
,
):
,
:
-
,
,
,
)
(
)–
1,3- -D-
:
:
:
),
31
29.08.2015
ESCMID Candida Guidelines 2012:
•
:3(
:
: 60
:
2
4)
: min 5
: 50-75% (
,
,
)
–
Candida !
:
32
29.08.2015
:
,
):
,
:
-
,
,
,
)
(
)–
1,3- -D-
:
33
29.08.2015
1,3- -D-
1-3
:
(>0,5):
:
,
,…
(?)
(>1,0)
34
29.08.2015
: SeptiFast
: SeptiFast
35
29.08.2015
: FISH
,
FISH – 5
PCR-RFLP – 20
:
–
6
.
: MALDI-TOF- 98,9 %
PCR-MLST
36
29.08.2015
:
:
:
:
Fungitest
Sensititre YeastOne
:
VITEK 2
ATB Fungus
:
Fungitest
Sensititre
YO
Vitek 2
E-
37
29.08.2015
Aspergillus spp.:
:
SCARE
in vitro
38
29.08.2015
39