臨床検査64巻7号

2020年07月発行

今月の特集2 薬剤耐性カンジダを考える

臨床における薬剤耐性カンジダ症の問題

著者： 木村宗芳¹ 荒岡秀樹¹

所属機関： ¹国家公務員共済組合連合会虎の門病院臨床感染症科

ページ範囲：P.792 - P.797

Point

●薬剤耐性カンジダ症の理解にはカンジダ症における薬剤感受性試験の適応を理解することが重要である．

●侵襲性カンジダ症においては，原因がCandida glabrataである場合，または適切な治療を行っているにもかかわらず感染が遷延する状況にある場合に薬剤耐性を考慮し，薬剤感受性試験を行う．

●抗真菌薬投与下に発症するbreakthroughカンジダ症では耐性が原因になることがしばしばあるため，原因カンジダ菌種の薬剤感受性試験の実施を検討してもいいだろう．

参考文献

1）Pappas PG, Kauffman CA, Andes DR, et al：Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis　62：e1-e50，2016

2）Pfaller MA：Antifungal susceptibility testing, 2019（https://www.uptodate.com/contents/antifungal-susceptibility-testing）（最終アクセス：2020年4月22日）

3）Ko JH, Peck KR, Jung DS, et al：Impact of high MIC of fluconazole on outcomes of Candida glabrata bloodstream infection: a retrospective multicenter cohort study. Diagn Microbiol Infect Dis　92：127-132，2018

4）Alexander BD, Johnson MD, Pfeiffer CD, et al：Increasing echinocandin resistance in Candida glabrata: clinical failure correlates with presence of FKS mutations and elevated minimum inhibitory concentrations. Clin Infect Dis　56：1724-1732，2013

5）Wang H, Fan YY, Kudinha T, et al：A Comprehensive Evaluation of the Bruker Biotyper MS and Vitek MS Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry Systems for Identification of Yeasts, Part of the National China Hospital Invasive Fungal Surveillance Net (CHIF-NET) Study, 2012 to 2013. J Clin Microbiol　54：1376-1380，2016

6）Stevenson LG, Drake SK, Shea YR, et al：Evaluation of matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of clinically important yeast species. J Clin Microbiol　48：3482-3486，2010

7）Cornely OA, Hoenigl M, Lass-Flörl C, et al：Defining breakthrough invasive fungal infection-Position paper of the mycoses study group education and research consortium and the European Confederation of Medical Mycology. Mycoses　62：716-729，2019

8）Kimura M, Araoka H, Yamamoto H, et al：Clinical and Microbiological Characteristics of Breakthrough Candidemia in Allogeneic Hematopoietic Stem Cell Transplant Recipients in a Japanese Hospital. Antimicrob Agents Chemother　61.pii：e01791-16，2017

9）Pfeiffer CD, Garcia-Effron G, Zaas AK, et al：Breakthrough invasive candidiasis in patients on micafungin. J Clin Microbiol　48：2373-2380，2010

10）Gamaletsou MN, Daikos GL, Walsh TJ, et al：Breakthrough candidaemia caused by phenotypically susceptible Candida spp. in patients with haematological malignancies does not correlate with established interpretive breakpoints. Int J Antimicrob Agents　44：248-255，2014

11）Wingard JR：Prophylaxis of invasive fungal infections in adults with hematologic malignancies，2019（https://www.uptodate.com/contents/prophylaxis-of-invasive-fungal-infections-in-adults-with-hematologic-malignancies）（最終アクセス：2020年4月22日）

12）Wingard JR：Prophylaxis of invasive fungal infections in adult hematopoietic cell transplant recipients，2019（https://www.uptodate.com/contents/prophylaxis-of-invasive-fungal-infections-in-adult-hematologic-cell-transplant-recipients）（最終アクセス：2020年4月22日）

13）Cesaro S, Tridello G, Blijlevens N, et al：Incidence, Risk Factors, and Long-term Outcome of Acute Leukemia Patients With Early Candidemia After Allogeneic Stem Cell Transplantation: A Study by the Acute Leukemia and Infectious Diseases Working Parties of European Society for Blood and Marrow Transplantation. Clin Infect Dis　67：564-572，2018

14）Leventakos K, Lewis RE, Kontoyiannis DP：Fungal infections in leukemia patients: how do we prevent and treat them?. Clin Infect Dis　50：405-415，2010

15）Chong Y, Shimoda S, Yakushiji H, et al：Fatal candidemia caused by azole-resistant Candida tropicalis in patients with hematological malignancies. J Infect Chemother　18：741-746，2012

16）Cornely OA, Maertens J, Winston DJ, et al：Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med　356：348-359，2007

17）Rausch CR, DiPippo AJ, Bose P, et al：Breakthrough Fungal Infections in Patients With Leukemia Receiving Isavuconazole. Clin Infect Dis　67：1610-1613，2018

18）Lionakis MS, Lewis RE, Kontoyiannis DP：Breakthrough Invasive Mold Infections in the Hematology Patient: Current Concepts and Future Directions. Clin Infect Dis　67：1621-1630，2018

19）Kimura M, Araoka H, Yamamoto H, et al：Micafungin Breakthrough Fungemia in Patients with Hematological Disorders. Antimicrob Agents Chemother　62.pii：e02183-17，2018

20）Sipsas NV, Lewis RE, Tarrand J, et al：Candidemia in patients with hematologic malignancies in the era of new antifungal agents (2001-2007): stable incidence but changing epidemiology of a still frequently lethal infection. Cancer　115：4745-4752，2009