侵入性黴菌感染及感染控制

Invasive Fungal Infection and Infection Control

侵入性黴菌感染常造成重症病人嚴重的發病率及致死率。最常被發現危及病人生命的黴菌感染是白色念珠菌及薰煙麴菌（Aspergillus fumigatus），但是其他類酵母的黴菌、黑色黴菌及絲狀真菌等黴菌感染也有增多的跡象。臨床經常使用fluconazole作為念珠菌感染的預防性治療用藥，但亦發現此策略與麴黴菌屬的侵入性感染及絲狀黴菌感染症的增加有直接相關。本篇主要針對侵入性黴菌感染的流行病學改變、危險因子與感染控制策略進行討論。對於本文的瞭解將有助於針對免疫缺陷及免疫抑制病患設計治療的策略與有效的預防性治療，進而可以改善病人的預後。

Invasive fungal infections (IFIs) are increasingly resulting in severe morbidity and mortality in critically ill, hospitalized patients. The majority of these life-threatening infections are caused by the well-known opportunistic pathogens-Candida albicans and Aspergillus fumigatus-but new opportunistic pathogens, including yeast-like and other filamentous fungi, have emerged as additional causative pathogens. Furthermore, the use of fluconazole prophylaxis against infection caused by Candida species has coincided with an increase in the incidence of invasive aspergillosis and infections caused by other filamentous fungi. This review highlights the epidemiologic changes and risk factors of IFIs and strategies for infection control. Knowledge regarding these issues is particularly important when developing therapeutic strategies and effective prophylaxis to improve the prognosis of immunosuppressed and immunocompromised patients.