Преимущества раннего назначения антимикотической терапии у гематологических пациентов

Инвазивные грибковые инфекции (ИГИ) представляют серьезную угрозу для пациентов с гематологическими заболеваниями. Эти инфекции характеризуются высокой летальностью и приводят к значительным финансовым затратам на лечение. Наиболее частыми возбудителями ИГИ являются Aspergillus spp. и Candida spp., но в последние годы участились случаи инфекций, вызванных редкими возбудителями. Диагностика ИГИ и выбор стратегии терапии остаются сложными задачами из‑за неспецифичности симптомов и разнообразия клинических случаев. В связи с этим вопрос о времени начала и выборе стратегии антимикотической терапии остается актуальным. В данном обзоре кратко описаны диагностические критерии, проблемы, связанные с диагностикой ИГИ, приведены данные об эмпирической и превентивной стратегиях как о двух подходах раннего лечения, а также рассмотрено влияние начала терапии на исходы. Лечение ИГИ у гематологических пациентов должно быть индивидуализировано. При этом раннее назначение терапии препаратами широкого спектра действия при фебрильной нейтропении и параллельное проведение диагностических мероприятий могут улучшить результаты лечения. Отмечена нехватка актуальных данных о преимуществах конкретных стратегий лечения, что подчеркивает необходимость дальнейших исследований в этой области.

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