血液領域における侵襲性真菌感染症の治療戦略
血液領域の真菌感染症診療においても，新規抗真菌薬の登場，画像・バイオマーカーによる診断能の向上によって治療戦略の選択の幅が広がった．一方で，抗真菌薬は一定の頻度で有害事象がみられ，薬物相互作用を有するものも多いこと，また，新規薬剤の使用が広まることによる薬剤耐性やブレイクスルー感染症の懸念などもあることから，抗真菌薬の適正使用は，より一層重要な課題となっている．医師，薬剤師，看護師，検査技師など多職種が関わりながら診療にあたることで，より質の高い真菌感染症診療の実践につながると考える．...
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| Published in | 日本医真菌学会雑誌 Vol. 63; no. 3; pp. 67 - 74 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本医真菌学会
2022
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 2434-5229 2434-5237 |
| DOI | 10.11534/ishinkin.22.007 |
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| Abstract | 血液領域の真菌感染症診療においても，新規抗真菌薬の登場，画像・バイオマーカーによる診断能の向上によって治療戦略の選択の幅が広がった．一方で，抗真菌薬は一定の頻度で有害事象がみられ，薬物相互作用を有するものも多いこと，また，新規薬剤の使用が広まることによる薬剤耐性やブレイクスルー感染症の懸念などもあることから，抗真菌薬の適正使用は，より一層重要な課題となっている．医師，薬剤師，看護師，検査技師など多職種が関わりながら診療にあたることで，より質の高い真菌感染症診療の実践につながると考える． |
|---|---|
| AbstractList | 血液領域の真菌感染症診療においても，新規抗真菌薬の登場，画像・バイオマーカーによる診断能の向上によって治療戦略の選択の幅が広がった．一方で，抗真菌薬は一定の頻度で有害事象がみられ，薬物相互作用を有するものも多いこと，また，新規薬剤の使用が広まることによる薬剤耐性やブレイクスルー感染症の懸念などもあることから，抗真菌薬の適正使用は，より一層重要な課題となっている．医師，薬剤師，看護師，検査技師など多職種が関わりながら診療にあたることで，より質の高い真菌感染症診療の実践につながると考える． |
| Author | 木村, 俊一 |
| Author_xml | – sequence: 1 fullname: 木村, 俊一 organization: 自治医科大学附属さいたま医療センター血液科 |
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| Copyright | 2022 一般社団法人日本医真菌学会 |
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| DOI | 10.11534/ishinkin.22.007 |
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| References | 16） Kanda Y, Kimura SI, Iino M, et al: D-index-guided early antifungal therapy versus empiric antifungal therapy for persistent febrile neutropenia: a randomized controlled noninferiority trial. J Clin Oncol 38: 815–822, 2020. 18） Kimura SI, Kameda K, Harada K, et al: Risk and predictive factors for candidemia after allogeneic hematopoietic cell transplantation: JSTCT Transplant Complications Working Group. Transplant Cell Ther 28: 209.e1–209.e9, 2022. 19） Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD: Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 62: e1–e50, 2016. 4） Chau MM, Daveson K, Alffenaar JC, Gwee A, Ho SA, Marriott DJE, Trubiano JA, Zhao J, Roberts JA: Consensus guidelines for optimising antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haematological malignancy and haemopoietic stem cell transplant recipients, 2021. Intern Med J 51 (Suppl 7): 37–66, 2021. 7） Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR: Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 52: e56–e93, 2011. 3） Even C, Bastuji-Garin S, Hicheri Y, Pautas C, Botterel F, Maury S, Cabanne L, Bretagne S, Cordonnier C: Impact of invasive fungal disease on the chemotherapy schedule and event-free survival in acute leukemia patients who survived fungal disease: a case-control study. Haematologica 96: 337–341, 2011. 23） Patterson TF, Thompson GR 3rd, Denning DW, et al: Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 63: e1–e60, 2016. 30） Skiada A, Pagano L, Groll A, et al: Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect 17: 1859–1867, 2011. 33） Cornely OA, Arikan-Akdagli S, Dannaoui E, et al: ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect 20 (Suppl 3): 5–26, 2014. 27） Maertens JA, Rahav G, Lee DG, et al: Posaconazole versus voriconazole for primary treatment of invasive aspergillosis: a phase 3, randomised, controlled, non-inferiority trial. Lancet 397: 499–509, 2021. 17） 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: e01791-16, 2017. 15） Kimura S, Oshima K, Sato K, Sato M, Terasako K, Nakasone H, Kikuchi M, Okuda S, Kako S, Yamazaki R, Tanaka Y, Tanihara A, Nishida J, Kanda Y: Retrospective evaluation of the area over the neutrophil curve index to predict early infection in hematopoietic stem cell transplantation recipients. Biol Blood Marrow Transplant 16: 1355–1361, 2010. 28） Douglas AP, Smibert OC, Bajel A, Halliday CL, Lavee O, McMullan B, Yong MK, van Hal SJ, Chen SC: Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021. Intern Med J 51 (Suppl 7): 143–176, 2021. 5） Khanina A, Tio SY, Ananda-Rajah MR, Kidd SE, Williams E, Chee L, Urbancic K, Thursky KA: Consensus guidelines for antifungal stewardship, surveillance and infection prevention, 2021. Intern Med J 51 Suppl 7: 18–36, 2021. 25） Ullmann AJ, Aguado JM, Arikan-Akdagli S, et al: Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 24 (suppl 1): e1–e38, 2018. 21） Herbrecht R, Denning DW, Patterson TF, et al: Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 347: 408–415, 2002. 31） Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC, Chu JH, Kontoyiannis DP, Walsh TJ: Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 41: 634–653, 2005. 37） Brüggemann RJ, Verheggen R, Boerrigter E, Stanzani M, Verweij PE, Blijlevens NMA, Lewis RE: Management of drug-drug interactions of targeted therapies for haematological malignancies and triazole antifungal drugs. Lancet Haematol 9: e58–e72, 2022. 13） Arvanitis M, Anagnostou T, Mylonakis E: Galactomannan and polymerase chain reaction-based screening for invasive aspergillosis among high-risk hematology patients: a diagnostic meta-analysis. Clin Infect Dis 61: 1263–1272, 2015. 36） DiNardo CD, Wei AH: How I treat acute myeloid leukemia in the era of new drugs. Blood 135: 85–96, 2020. 11） Nucci M, Anaissie E: How we treat invasive fungal diseases in patients with acute leukemia: the importance of an individualized approach. Blood 124: 3858–3869, 2014. 26） Tissot F, Agrawal S, Pagano L, Petrikkos G, Groll AH, Skiada A, Lass-Flörl C, Calandra T, Viscoli C, Herbrecht R: ECIL-6 guidelines for the treatment of invasive candidiasis, aspergillosis and mucormycosis in leukemia and hematopoietic stem cell transplant patients. Haematologica 102: 433–444, 2017. 6） Robenshtok E, Gafter-Gvili A, Goldberg E, Weinberger M, Yeshurun M, Leibovici L, Paul M: Antifungal prophylaxis in cancer patients after chemotherapy or hematopoietic stem-cell transplantation: systematic review and meta-analysis. J Clin Oncol 25: 5471–5489, 2007. 35） Marr KA, Leisenring W, Crippa F, Slattery JT, Corey L, Boeckh M, McDonald GB: Cyclophosphamide metabolism is affected by azole antifungals. Blood 103: 1557–1559, 2004. 29） Marr KA, Schlamm HT, Herbrecht R, et al: Combination antifungal therapy for invasive aspergillosis: a randomized trial. Ann Intern Med 162: 81–89, 2015. 34） Cornely OA, Alastruey-Izquierdo A, Arenz D, et al: Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis 19: e405–e421, 2019. 9） Kimura SI, Fujita H, Handa H, Hiramoto N, Hosono N, Minamiguchi H, Takahashi T, Kato H, Ono T, Kanda Y, Kiyoi H, Matsumura I, Miyazaki Y: Real-world management of infection during chemotherapy for acute leukemia in Japan: from the results of a nationwide questionnaire-based survey by the Japan Adult Leukemia Study Group. Int J Hematol 112: 409–417, 2020. 1） Neofytos D, Horn D, Anaissie E, Steinbach W, Olyaei A, Fishman J, Pfaller M, Chang C, Webster K, Marr K: Epidemiology and outcome of invasive fungal infection in adult hematopoietic stem cell transplant recipients: analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance registry. Clin Infect Dis 48: 265–273, 2009. 8） Maertens JA, Girmenia C, Brüggemann RJ, et al: European guidelines for primary antifungal prophylaxis in adult haematology patients: summary of the updated recommendations from the European Conference on Infections in Leukaemia. J Antimicrob Chemother 73: 3221–3230, 2018. 20） 一般社団法人日本医真菌学会：侵襲性カンジダ症に対するマネジメントのための臨床実践ガイドライン．日本医真菌学会，東京，2021. 14） Portugal RD, Garnica M, Nucci M: Index to predict invasive mold infection in high-risk neutropenic patients based on the area over the neutrophil curve. J Clin Oncol 27: 3849–3854, 2009. 38） Park WB, Kim NH, Kim KH, Lee SH, Nam WS, Yoon SH, Song KH, Choe PG, Kim NJ, Jang IJ, Oh MD, Yu KS: The effect of therapeutic drug monitoring on safety and efficacy of voriconazole in invasive fungal infections: a randomized controlled trial. Clin Infect Dis 55: 1080–1087, 2012. 22） Cornely OA, Maertens J, Bresnik M, et al: Liposomal amphotericin B as initial therapy for invasive mold infection: a randomized trial comparing a high-loading dose regimen with standard dosing (AmBiLoad trial). Clin Infect Dis 44: 1289–1297, 2007. 32） Petraitis V, Petraitiene R, Antachopoulos C, Hughes JE, Cotton MP, Kasai M, Harrington S, Gamaletsou MN, Bacher JD, Kontoyiannis DP, Roilides E, Walsh TJ: Increased virulence of Cunninghamella bertholletiae in experimental pulmonary mucormycosis: correlation with circulating molecular biomarkers, sporangiospore germination and hyphal metabolism. Med Mycol 51: 72–82, 2013. 24） Maertens JA, Raad II, Marr KA, et al: Isavuconazole versus voriconazole for primary treatment of invasive mould disease caused by Aspergillus and other filamentous fungi (SECURE): a phase 3, randomised-controlled, non-inferiority trial. Lancet 387: 760–769, 2016. 12） Cordonnier C, Pautas C, Maury S, Vekhoff A, Farhat H, Suarez F, Dhédin N, Isnard F, Ades L, Kuhnowski F, Foulet F, Kuentz M, Maison P, Bretagne S, Schwarzinger M: Empirical versus preemptive antifungal therapy for high-risk, febrile, neutropenic patients: a randomized, controlled trial. Clin Infect Dis 48: 1042–1051, 2009. 10） Cornely OA, Maertens J, Winston DJ, Perfect J, Ullmann AJ, Walsh TJ, Helfgott D, Holowiecki J, Stockelberg D, Goh YT, Petrini M, Hardalo C, Suresh R, Angulo-Gonzalez D: Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med 356: 348–359, 2007. 2） Kontoyiannis DP, Marr KA, Park BJ, et al: Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis 50: 1091–1100, 2010. |
| References_xml | – reference: 24） Maertens JA, Raad II, Marr KA, et al: Isavuconazole versus voriconazole for primary treatment of invasive mould disease caused by Aspergillus and other filamentous fungi (SECURE): a phase 3, randomised-controlled, non-inferiority trial. Lancet 387: 760–769, 2016. – reference: 3） Even C, Bastuji-Garin S, Hicheri Y, Pautas C, Botterel F, Maury S, Cabanne L, Bretagne S, Cordonnier C: Impact of invasive fungal disease on the chemotherapy schedule and event-free survival in acute leukemia patients who survived fungal disease: a case-control study. Haematologica 96: 337–341, 2011. – reference: 27） Maertens JA, Rahav G, Lee DG, et al: Posaconazole versus voriconazole for primary treatment of invasive aspergillosis: a phase 3, randomised, controlled, non-inferiority trial. Lancet 397: 499–509, 2021. – reference: 38） Park WB, Kim NH, Kim KH, Lee SH, Nam WS, Yoon SH, Song KH, Choe PG, Kim NJ, Jang IJ, Oh MD, Yu KS: The effect of therapeutic drug monitoring on safety and efficacy of voriconazole in invasive fungal infections: a randomized controlled trial. Clin Infect Dis 55: 1080–1087, 2012. – reference: 6） Robenshtok E, Gafter-Gvili A, Goldberg E, Weinberger M, Yeshurun M, Leibovici L, Paul M: Antifungal prophylaxis in cancer patients after chemotherapy or hematopoietic stem-cell transplantation: systematic review and meta-analysis. J Clin Oncol 25: 5471–5489, 2007. – reference: 33） Cornely OA, Arikan-Akdagli S, Dannaoui E, et al: ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect 20 (Suppl 3): 5–26, 2014. – reference: 37） Brüggemann RJ, Verheggen R, Boerrigter E, Stanzani M, Verweij PE, Blijlevens NMA, Lewis RE: Management of drug-drug interactions of targeted therapies for haematological malignancies and triazole antifungal drugs. Lancet Haematol 9: e58–e72, 2022. – reference: 21） Herbrecht R, Denning DW, Patterson TF, et al: Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 347: 408–415, 2002. – reference: 35） Marr KA, Leisenring W, Crippa F, Slattery JT, Corey L, Boeckh M, McDonald GB: Cyclophosphamide metabolism is affected by azole antifungals. Blood 103: 1557–1559, 2004. – reference: 30） Skiada A, Pagano L, Groll A, et al: Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect 17: 1859–1867, 2011. – reference: 36） DiNardo CD, Wei AH: How I treat acute myeloid leukemia in the era of new drugs. Blood 135: 85–96, 2020. – reference: 5） Khanina A, Tio SY, Ananda-Rajah MR, Kidd SE, Williams E, Chee L, Urbancic K, Thursky KA: Consensus guidelines for antifungal stewardship, surveillance and infection prevention, 2021. Intern Med J 51 Suppl 7: 18–36, 2021. – reference: 32） Petraitis V, Petraitiene R, Antachopoulos C, Hughes JE, Cotton MP, Kasai M, Harrington S, Gamaletsou MN, Bacher JD, Kontoyiannis DP, Roilides E, Walsh TJ: Increased virulence of Cunninghamella bertholletiae in experimental pulmonary mucormycosis: correlation with circulating molecular biomarkers, sporangiospore germination and hyphal metabolism. Med Mycol 51: 72–82, 2013. – reference: 11） Nucci M, Anaissie E: How we treat invasive fungal diseases in patients with acute leukemia: the importance of an individualized approach. Blood 124: 3858–3869, 2014. – reference: 4） Chau MM, Daveson K, Alffenaar JC, Gwee A, Ho SA, Marriott DJE, Trubiano JA, Zhao J, Roberts JA: Consensus guidelines for optimising antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haematological malignancy and haemopoietic stem cell transplant recipients, 2021. Intern Med J 51 (Suppl 7): 37–66, 2021. – reference: 12） Cordonnier C, Pautas C, Maury S, Vekhoff A, Farhat H, Suarez F, Dhédin N, Isnard F, Ades L, Kuhnowski F, Foulet F, Kuentz M, Maison P, Bretagne S, Schwarzinger M: Empirical versus preemptive antifungal therapy for high-risk, febrile, neutropenic patients: a randomized, controlled trial. Clin Infect Dis 48: 1042–1051, 2009. – reference: 26） Tissot F, Agrawal S, Pagano L, Petrikkos G, Groll AH, Skiada A, Lass-Flörl C, Calandra T, Viscoli C, Herbrecht R: ECIL-6 guidelines for the treatment of invasive candidiasis, aspergillosis and mucormycosis in leukemia and hematopoietic stem cell transplant patients. Haematologica 102: 433–444, 2017. – reference: 2） Kontoyiannis DP, Marr KA, Park BJ, et al: Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis 50: 1091–1100, 2010. – reference: 17） 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: e01791-16, 2017. – reference: 22） Cornely OA, Maertens J, Bresnik M, et al: Liposomal amphotericin B as initial therapy for invasive mold infection: a randomized trial comparing a high-loading dose regimen with standard dosing (AmBiLoad trial). Clin Infect Dis 44: 1289–1297, 2007. – reference: 13） Arvanitis M, Anagnostou T, Mylonakis E: Galactomannan and polymerase chain reaction-based screening for invasive aspergillosis among high-risk hematology patients: a diagnostic meta-analysis. Clin Infect Dis 61: 1263–1272, 2015. – reference: 25） Ullmann AJ, Aguado JM, Arikan-Akdagli S, et al: Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 24 (suppl 1): e1–e38, 2018. – reference: 23） Patterson TF, Thompson GR 3rd, Denning DW, et al: Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 63: e1–e60, 2016. – reference: 9） Kimura SI, Fujita H, Handa H, Hiramoto N, Hosono N, Minamiguchi H, Takahashi T, Kato H, Ono T, Kanda Y, Kiyoi H, Matsumura I, Miyazaki Y: Real-world management of infection during chemotherapy for acute leukemia in Japan: from the results of a nationwide questionnaire-based survey by the Japan Adult Leukemia Study Group. Int J Hematol 112: 409–417, 2020. – reference: 16） Kanda Y, Kimura SI, Iino M, et al: D-index-guided early antifungal therapy versus empiric antifungal therapy for persistent febrile neutropenia: a randomized controlled noninferiority trial. J Clin Oncol 38: 815–822, 2020. – reference: 31） Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC, Chu JH, Kontoyiannis DP, Walsh TJ: Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 41: 634–653, 2005. – reference: 19） Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD: Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 62: e1–e50, 2016. – reference: 10） Cornely OA, Maertens J, Winston DJ, Perfect J, Ullmann AJ, Walsh TJ, Helfgott D, Holowiecki J, Stockelberg D, Goh YT, Petrini M, Hardalo C, Suresh R, Angulo-Gonzalez D: Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med 356: 348–359, 2007. – reference: 28） Douglas AP, Smibert OC, Bajel A, Halliday CL, Lavee O, McMullan B, Yong MK, van Hal SJ, Chen SC: Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021. Intern Med J 51 (Suppl 7): 143–176, 2021. – reference: 34） Cornely OA, Alastruey-Izquierdo A, Arenz D, et al: Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis 19: e405–e421, 2019. – reference: 15） Kimura S, Oshima K, Sato K, Sato M, Terasako K, Nakasone H, Kikuchi M, Okuda S, Kako S, Yamazaki R, Tanaka Y, Tanihara A, Nishida J, Kanda Y: Retrospective evaluation of the area over the neutrophil curve index to predict early infection in hematopoietic stem cell transplantation recipients. Biol Blood Marrow Transplant 16: 1355–1361, 2010. – reference: 29） Marr KA, Schlamm HT, Herbrecht R, et al: Combination antifungal therapy for invasive aspergillosis: a randomized trial. Ann Intern Med 162: 81–89, 2015. – reference: 14） Portugal RD, Garnica M, Nucci M: Index to predict invasive mold infection in high-risk neutropenic patients based on the area over the neutrophil curve. J Clin Oncol 27: 3849–3854, 2009. – reference: 8） Maertens JA, Girmenia C, Brüggemann RJ, et al: European guidelines for primary antifungal prophylaxis in adult haematology patients: summary of the updated recommendations from the European Conference on Infections in Leukaemia. J Antimicrob Chemother 73: 3221–3230, 2018. – reference: 18） Kimura SI, Kameda K, Harada K, et al: Risk and predictive factors for candidemia after allogeneic hematopoietic cell transplantation: JSTCT Transplant Complications Working Group. Transplant Cell Ther 28: 209.e1–209.e9, 2022. – reference: 1） Neofytos D, Horn D, Anaissie E, Steinbach W, Olyaei A, Fishman J, Pfaller M, Chang C, Webster K, Marr K: Epidemiology and outcome of invasive fungal infection in adult hematopoietic stem cell transplant recipients: analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance registry. Clin Infect Dis 48: 265–273, 2009. – reference: 20） 一般社団法人日本医真菌学会：侵襲性カンジダ症に対するマネジメントのための臨床実践ガイドライン．日本医真菌学会，東京，2021. – reference: 7） Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR: Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 52: e56–e93, 2011. |
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| SubjectTerms | 侵襲性アスペルギルス症 侵襲性カンジダ症 侵襲性真菌感染症 急性白血病 抗真菌薬 造血細胞移植 |
| Title | 血液領域における侵襲性真菌感染症の治療戦略 |
| URI | https://www.jstage.jst.go.jp/article/ishinkin/63/3/63_22.007/_article/-char/ja |
| Volume | 63 |
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| ispartofPNX | 日本医真菌学会雑誌, 2022, Vol.63(3), pp.67-74 |
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