OncohematologyOncohematologyОнкогематология1818-83462413-4023Publishing House ABV Press90210.17650/1818-8346-2024-19-1-99-112SUPPORTIVE THERAPY ASPECTSАСПЕКТЫ ПОДДЕРЖИВАЮЩЕЙ ТЕРАПИИBenefits of early antifungal therapy in hematology patientsПреимущества раннего назначения антимикотической терапии у гематологических пациентовhttps://orcid.org/0000-0002-9147-4636AndreevS. S.АндреевС. С.
Russian Federation

Sergey Sergeevich Andreev

Build. 3, 3 Pekhotnaya St., Moscow 123182

Сергей Сергеевич Андреев

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nerowolf@mail.ruhttps://orcid.org/0000-0002-0694-3996BroninG. O.БронинГ. О.
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 1/9, 4 Dobryninskiy Pereulok, Moscow 119049

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Russian Federation

24 Kashirskoe Shosse, Moscow 11552

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https://orcid.org/0000-0002-2467-4945KozlovaO. P.КозловаО. П.
Russian Federation

194291 Санкт-Петербург, ул. Сантьяго-де-Куба, 1/28

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Russian Federation

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https://orcid.org/0000-0002-3272-5263ShadrivovaO. V.ШадривоваО. В.
Russian Federation

1/28 Santiago de Cuba St., Saint Petersburg 194291

194291 Санкт-Петербург, ул. Сантьяго-де-Куба, 1/28

Moscow City Clinical Hospital 52ГБУЗ г. Москвы «Городская клиническая больница №52 Департамента здравоохранения г. МосквыMorozov Children’s City Clinical Hospital of the Moscow Healthcare DepartmentГБУЗ г. Москвы «Морозовская детская городская клиническая больница Департамента здравоохранения г. Москвы»N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава РоссииNorth-Western State Medical University named after I.I. Mechnikov, Ministry of Health of RussiaФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииRussian Children’s Clinical Hospital ‒ branch of the N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaРоссийская детская клиническая больница – филиал ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России27012024191991122701202427012024https://oncohematology.abvpress.ru/ongm/article/view/902

Invasive fungal infections (IFIs) are a serious threat to patients with hematological diseases. These infections are characterized by high mortality and lead to significant financial costs for treatment. The most common pathogens of IFIs are Aspergillus spp. and Candida spp., but in recent years, cases of infections caused by rare pathogens have become more frequent. Diagnosis of IFIs and choice of treatment remain challenging due to the nonspecificity of symptoms and the diversity of clinical cases. In this regard, the problem of start time and choice of antifungal therapy remains of current interest. This review briefly describes diagnostic criteria, challenges associated with IFIs diagnosing, provides evidence for empiric and preventive strategies as two early treatment approaches, and examines the impact of therapy initiation on patient outcomes. Treatment of IFIs in hematologic patients should be individualized. At the same time, early administration of therapy with broad-spectrum drugs for febrile neutropenia and parallel diagnostic measures can improve treatment outcomes. There is a lack of current data on the benefits of specific treatment strategies, highlighting the need for further research.

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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