生物被膜与CVC相关感染的抗真菌管理精选.ppt

2009 IDSA指南:导管相关真菌感染处理原则——恰当的抗真菌治疗与及时拔出导管同样重要 疑似导管相关念珠菌血症患者，经验性治疗选用棘白菌素，部分患者可选用氟康唑（A-II）。棘白菌素用于危重患者，直至鉴定出菌种。 下列情况应移除导管： 长程导管CRBSI：严重脓毒症、化脓性血栓性静脉炎、心内膜炎、抗生素治疗72h血流感染持续、或为金葡菌、肠球菌属、单胞菌、真菌、分枝杆菌感染（A-II） 短程导管CRBSI：革兰氏阴性杆菌、金葡菌、肠球菌属、单胞菌、真菌、分枝杆菌感染（A-II） Clinical Infectious Diseases 2009; 49:1–45 2012 ESCMID指南CVC相关性念珠菌血症管理 患者人群 治疗干预 SoR QoE 移除中心静脉导管 移除留置导管（勿用导丝） A Ⅱr 无法移除中心静脉导管 棘白菌素类、脂质体两性霉素B或两性霉素B脂质复合体 B Ⅱr 唑类、或两性霉素B去氧胆酸盐 D Ⅱr 干预治疗旨在清除念珠菌血症并改善生存率 -*- Cornely et al. Clin Microb Infect 2012; DOI: 10.1111/1469-0691.12039 r: 随机对照研究的Meta分析或系统回顾 小 结 生物被膜是念珠菌感染常见的耐药机制 β-1,3?glucan是念珠菌生物被膜重要组成部分，棘白菌素类药物具有良好的抗生物被膜活性 CVC相关血行感染的抗真菌管理，生物被膜是需要考虑的重要因素 对于怀疑念珠菌感染的患者，适当的抗真菌治疗与及时拔除导管同样重要，特别是对于危重患者 谢谢！ * Figure 1. Schematic of C. albicans biofilm development over time. Attachment: pioneering yeast cells adhere to a substrate, such as a polystyrene plate, an implanted medical device, or a host surface. Initiation: biofilm development begins with cell-cell adhesion and proliferation. Maturation: hyphal cells form and the biofilm is encased in a secreted, extracellular matrix. Dispersal: cells bud off of the biofilm and are dispersed to seed new locations. * Structure of the Candida albicans cell wall Biofilm and planktonic cell wall carbohydrate composition. Biofilm cells were collected from the in vitro silicone disk assay. Planktonic cells were collected in both log and stationary phases of growth. Each bar color represents a different cell wall fraction, with means and standard deviations from three biologic and three technical assay replicates. The data are expressed as micrograms of carbohydrate per 5 mg of dry cell weight. Carbohydrate concentrations of various fractions were estimated using the phenol-sulfuric acid methods with a glucose standard curve. *, biofilm cells contained significantly more β-1,3 glucan compared to planktonic cells in both stationary and log phases (P 0.001). Extracellular β-1,3 glucan concentrations from C. albicans biofilm and planktonic C. albicans in vi