真菌陈惠德教授__培训课件.ppt

Study population Demography: Underlying factors: Diagnosis: 20 patients 13 males, 7 females Mean age 45.1 years, range 16-68 years 17 hematologic malignancy 3 major abdominal surgery 12 central venous lines 13 candidemias (3 spesis syndrome) 6 disseminated candidiasis 1 invasive esophagitis de Pauw 20th ICC, 1997 High-Dose Fluconazole Rescue for Refractory Candida Infection High-Dose Fluconazole Rescue for Refractory Candida Infection Study outline Treatment: Inclusion criteria: Continue and change to oral treatment when feasible Good clinical response, well tolerated Maximum daily dose 1600 mg/day Initial treatment: 800 mg/day fluconazole for 3-5 days Inadequate clinical response, well tolerated Increas daily dose by 400 mg/day 3 days 3days Proven or highly probable invasive candida infection No response to fluconazole 400 mg daily Informed consent de Pauw 20th ICC, 1997 High-Dose Fluconazole Rescue for Refractory Candida Infection Outcome by diagnosis Patients (n) Maximum daily fluconazole dose (mg/day) Cured Failed 800 1200 1600 800 1200 1600 7 6 5 4 3 2 1 0 Candidemia Others de Pauw 20th ICC, 1997 High-Dose Fluconazole Rescue for Refractory Candida Infection Outcome by maximum dose Patients (n) Maximum daily fluconazole dose (mg/day) 800 1200 1600 9 8 7 6 5 4 3 2 1 0 Failed Cured de Pauw 20th ICC, 1997 High-Dose Fluconazole Rescue for Refractory Candida Infection Outcome by Candida isolates Number Cured Improved Failed C. albicans 11 7 (64%) 0 4(36%) C. glabrata 5 1 (20%) 1 (20%) 3 (60%) C. parapsilosis 1 1 0 0 C. kefyr 1 1 0 0 C. utilis 1 1 0 0 Total 19 11(58%) 1(5%) 7(37%) de Pauw 20th ICC, 1997 High-Dose Fluconazole Rescue for Refractory Candida Infection Therapy duration and side-effects Side-effects Therapy duration Outcome Mean treatment duration Range Success 30 days 4-155 days Failure 12 days 5-37 days Daily dose Number of cases Side-effects 800 mg 11 1 liver fun