泊沙康唑临床新实践.ppt

泊沙康唑预防真菌感染的 临床实践 2013年11月13日北京 Rafael duarte Director BMT Program and OICO myeloid Leukemia Services Catalan Institute of Oncology, Barcelona, Spain  POSACONAZOLE ANTIFUNGAL PROPHYLAXIS INTO CLINICAL PRACTICE 侵袭性真菌感染(IF)尤其是侵袭性曲霉菌感染(IA)仍旧有很 高的死亡率 研究 人群 结果 All-cause mortality at 90 days after diagnosis. upon2007405BM(94%ao) All with p/p IA 8%(1990-200)and55%;p001 63%death due to/with ia without other causes of death IFI attributable mortality was 65%in all cases. Pagano, 2007 3228BMT(39%alo) Fi121③37% 72%for Aspergillus and 50% for Candida Pagano, 2010 152 p/p IA in AML IA attributable mortality rate was 27% Baddley, 2010 42 p/p IA AIl-cause mortality at 12 weeks was 49% in BMt and SOT %in BMT vs 34% in SOT (p.001) Catalan Institute of Oncology, Barcelona, Spain  POSACONAZOLE ANTIFUNGAL PROPHYLAXIS INTO CLINICAL PRACTIC 如何降低死亡率、改善患者生存 新型诊图 方法 预防 治疗 Catalan Institute of Oncology, Barcelona, Spain  POSACONAZOLE ANTIFUNGAL PROPHYLAXIS INTO CLINICAL PRACTIC IF的一个持续治疗模式 粗死亡率 40%90% 防 经验治疗 抢先治疗 目标治疗 X Catalan Institute of Oncology, Barcelona, Spain  POSACONAZOLE ANTIFUNGAL PROPHYLAXIS INTO CLINICAL PRACTICE 在患者死亡前,我们依旧用很长的时间去确诊F Hemato-Oncologist Infectious Diseases Catalan Insttute of Oncology, Barcelona, Saain  POSACONAZOLE ANTIFUNGAL PROPHYLAXIS INTO CLINICAL PRACTICE 在患者死亡前,我们依旧用很长的时间去确诊 尸检后 尸检前 67%的在 尸检前没有 被诊断 你认为F的发生率 是多少? and这是真的吗? %HF??? R.E. Lewis 2013 Catalan Institute of Oncology, Barcelona, Spain  POSACONAZOLE ANTIFUNGAL PROPHYLAXIS INTO CLINICAL PRACTICE 是否新的诊断工具能够改善生存率? 血液科高危患者 每天进行M试验监测和临床评估 2次GM 谱抗生素治疗无效胸片上出现新的浸润或霉菌培养或 ≥0.5的粒缺伴发热超过5天真菌感染的症状/病征镜检阳性 胸部CT检查(士鼻窦CT) 胸部CT 侵袭性真菌感染的特异CT 非特异征象 正常 征象:晕征 肺泡盥洗 支气管镜和支气管肺泡灌洗检查 广谱抗真菌治疗 继续监测,无抗真菌治疗 Catalan Institute of Oncology, Barcelona, Spain  POSACONAZOLE ANTIFUNGAL PROPHYLAXIS INTO CLINICAL PRACTICE 是否诊断驱动的治疗策暗能够改善生存率? WELL. UNDER NORMAL CIRCUMSTANCES DIAGNOSIMGAFUNKGAL IFEGIIN A VERy FOTHERGILL Catalan in ey