최소 단어 이상 선택하여야 합니다.
최대 10 단어까지만 선택 가능합니다.
다음과 같은 기능을 한번의 로그인으로 사용 할 수 있습니다.
NTIS 바로가기한국임상약학회지 = Korean journal of clinical pharmacy, v.29 no.2, 2019년, pp.89 - 100
손유정 (연세대학교 의과대학 세브란스병원 약무국) , 이경아 (연세대학교 의과대학 세브란스병원 약무국) , 조주희 (연세대학교 의과대학 세브란스병원 약무국) , 김재송 (연세대학교 의과대학 세브란스병원 약무국) , 손은선 (연세대학교 의과대학 세브란스병원 약무국) , 박무석 (연세대학교 의과대학 내과학교실)
Background: Invasive aspergillosis (IA) is associated with high morbidity and mortality, particularly among immunocompromised patients, such as lung transplant recipients. Voriconazole, the first-line therapy for IA, shows a non-linear pharmacokinetic profile and has a narrow therapeutic range. Care...
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
핵심어 | 질문 | 논문에서 추출한 답변 |
---|---|---|
침습성 진균감염이란 무엇인가 | 침습성 진균감염(invasive fungal infections, IFIs)은 주로 면역기능이 저하된 환자에서 발생하는 기회감염증으로, 항암요법이나 조혈모세포이식을 받는 환자와 면역억제제, 스테로이 드를 사용하는 환자, 인간면역결핍 바이러스(human immuno-deficiency virus, HIV) 감염 등 면역결핍증 환자에게 주로 발 생하며 최근 그 발생 빈도가 증가하고 있다.1) 그 중 침습성 아스페르길루스증(invasive aspergillosis)은 면역저하환자에서 생명을 위협하는 주요 질환으로 치료 실패율이 절반에 이르고, 진단 후 12주 이내에 사망할 확률이 30%에 이를 정도로 치명 적이다. | |
침습성 아스페르길루스증에 감염됐을 때 12주 이내 사망할 확률은 몇%인가 | 침습성 진균감염(invasive fungal infections, IFIs)은 주로 면역기능이 저하된 환자에서 발생하는 기회감염증으로, 항암요법이나 조혈모세포이식을 받는 환자와 면역억제제, 스테로이 드를 사용하는 환자, 인간면역결핍 바이러스(human immuno-deficiency virus, HIV) 감염 등 면역결핍증 환자에게 주로 발 생하며 최근 그 발생 빈도가 증가하고 있다.1) 그 중 침습성 아스페르길루스증(invasive aspergillosis)은 면역저하환자에서 생명을 위협하는 주요 질환으로 치료 실패율이 절반에 이르고, 진단 후 12주 이내에 사망할 확률이 30%에 이를 정도로 치명 적이다.2) 특히 고형 장기이식 중 폐이식을 받은 환자에게서 침습성 아스페르길루스증의 발현율은 15-35%이며 사망률은 약 60%에 육박한다. | |
TDM 시행군과 비시행군에 따라서 어떠한 양상을 보였는가? | Voriconazole 투여 시작 후 2주, 6주, 12주, 그리고 투여 종료시점에서 침습성 아스페르길루스증에 대한 치료 효과를 분석한 결과, 본 연구에서는 통계적으로 유의한 차이를 보이지는 않았으나, TDM 시행군에서 TDM 비시행군에 비해 치료 효과가 상승하는 경향성을 보였다. 또한 voriconazole 치료 실패에 따른 2차 약제로의 전환율은 TDM 시행군에서 유의하게 낮음을 확인할 수 있었다(p = 0.027). Voriconazole 투여 종료 사유 를 추가적으로 분석해본 결과, TDM 시행군의 경우 질환의 호전이 27명 중 13명(48.1%)으로 가장 높은 비율을 차지하였고, 2차 약제로의 전환(6명, 22.2%)이 그 뒤를 이었다. TDM 비시행군은 2차 약제로의 전환(15명, 55.6%), 혹은 질환의 호전(11 명, 40.7%)에 의해 voriconazole 투여를 종료한 경우가 대부분 이었다. 2차 약제로의 전환은 곧 voriconazole 치료 실패를 의미하므로 이러한 결과를 통해 voriconazole 투여 시 TDM을 시행함으로써 치료 실패율이 감소하였음을 간접적으로 확인 할 수 있다. |
Badiee P, Hashemizadeh Z. Opportunistic invasive fungal infections:diagnosis &clinical management. Indian J Med Res 2014;139(2):195-204.
Maschmeyer, Georg, Haas, Antje, Cornely, Oliver A. Invasive Aspergillosis : Epidemiology, Diagnosis and Management in Immunocompromised Patients. Drugs, vol.67, no.11, 1567-1601.
Gavalda, J., Meije, Y., Fortun, J., Roilides, E., Saliba, F., Lortholary, O., Munoz, P., Grossi, P., Cuenca-Estrella, M.. Invasive fungal infections in solid organ transplant recipients. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, vol.20, no.suppl7, 27-48.
Mitsani, Dimitra, Nguyen, M. Hong, Shields, Ryan K., Toyoda, Yoshiya, Kwak, Eun J., Silveira, Fernanda P., Pilewski, Joseph M., Crespo, Maria M., Bermudez, Christian, Bhama, Jay K., Clancy, Cornelius J.. Prospective, Observational Study of Voriconazole Therapeutic Drug Monitoring among Lung Transplant Recipients Receiving Prophylaxis: Factors Impacting Levels of and Associations between Serum Troughs, Efficacy, and Toxicity. Antimicrobial agents and chemotherapy, vol.56, no.5, 2371-2377.
Morgan, J., Wannemuehler, K. A., Marr, K. A., Hadley, S., Kontoyiannis, D. P., Walsh, T. J., Fridkin, S. K., Pappas, P. G., Warnock, D. W.. Incidence of invasive aspergillosis following hematopoietic stem cell and solid organ transplantation: interim results of a prospective multicenter surveillance program. Medical mycology : official publication of the International Society for Human and Animal Mycology, vol.43, no.suppl1, 49-58.
Lin, S.-J., Schranz, J., Teutsch, S. M.. Aspergillosis Case-Fatality Rate: Systematic Review of the Literature. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol.32, no.3, 358-366.
Patterson, Thomas F., Thompson III, George R., Denning, David W., Fishman, Jay A., Hadley, Susan, Herbrecht, Raoul, Kontoyiannis, Dimitrios P., Marr, Kieren A., Morrison, Vicki A., Nguyen, M. Hong, Segal, Brahm H., Steinbach, William J., Stevens, David A., Walsh, Thomas J., Wingard, John R., Young, Jo-Anne H., Bennett, John E.. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol.63, no.4, e1-e60.
Ullmann, A.J., Aguado, J.M., Arikan-Akdagli, S., Denning, D.W., Groll, A.H., Lagrou, K., Lass-Flörl, C., Lewis, R.E., Munoz, P., Verweij, P.E., Warris, A., Ader, F., Akova, M., Arendrup, M.C., Barnes, R.A., Beigelman-Aubry, C., Blot, S., Bouza, E., Brüggemann, R.J.M., Buchheidt, D., Cadranel, J., Castagnola, E., Chakrabarti, A., Cuenca-Estrella, M., Dimopoulos, G., Fortun, J., Gangneux, J.-P., Garbino, J., Heinz, W.J., Herbrecht, R., Heussel, C.P., Kibbler, C.C., Klimko, N., Kullberg, B.J., Lange, C., Lehrnbecher, T., Löffler, J., Lortholary, O., Maertens, J., Marchetti, O., Meis, J.F., Pagano, L., Ribaud, P., Richardson, M., Roilides, E., Ruhnke, M., Sanguinetti, M., Sheppard, D.C., Sinkó, J., Skiada, A., Vehreschild, M.J.G.T., Viscoli, C., Cornely, O.A.. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, vol.24, no.1, e1-e38.
Herbrecht, Raoul, Denning, David W., Patterson, Thomas F., Bennett, John E., Greene, Reginald E., Oestmann, Jörg-W., Kern, Winfried V., Marr, Kieren A., Ribaud, Patricia, Lortholary, Olivier, Sylvester, Richard, Rubin, Robert H., Wingard, John R., Stark, Paul, Durand, Christine, Caillot, Denis, Thiel, Eckhard, Chandrasekar, Pranatharthi H., Hodges, Michael R., Schlamm, Haran T., Troke, Peter F., de Pauw, Ben. Voriconazole versus Amphotericin B for Primary Therapy of Invasive Aspergillosis. The New England journal of medicine, vol.347, no.6, 408-415.
Lat, Asma, Thompson III, George R. Update on the optimal use of voriconazole for invasive fungal infections. Infection and drug resistance, vol.4, 43-53.
Kim, Sang Il, Kang, Moon Won. Current Usage and Prospect of New Antifungal agents in Korea. Infection & chemotherapy, vol.42, no.4, 209-.
Theuretzbacher, Ursula, Ihle, Franziska, Derendorf, Hartmut. Pharmacokinetic/Pharmacodynamic Profile of Voriconazole :. Clinical pharmacokinetics, vol.45, no.7, 649-663.
Andes, David, Pascual, Andres, Marchetti, Oscar. Antifungal Therapeutic Drug Monitoring: Established and Emerging Indications. Antimicrobial agents and chemotherapy, vol.53, no.1, 24-34.
Hashemizadeh, Zahra, Badiee, Parisa, Malekhoseini, Seyed Ali, Raeisi Shahraki, Hadi, Geramizadeh, Bita, Montaseri, Hashem. Observational Study of Associations between Voriconazole Therapeutic Drug Monitoring, Toxicity, and Outcome in Liver Transplant Patients. Antimicrobial agents and chemotherapy, vol.61, no.12, e01211-17-e01211-17.
Park, Wan Beom, Kim, Nak-Hyun, Kim, Kye-Hyung, Lee, Seung Hwan, Nam, Won-Seok, Yoon, Seo Hyun, Song, Kyoung-Ho, Choe, Pyoeng Gyun, Kim, Nam Joong, Jang, In-Jin, Oh, Myoung-don, Yu, Kyung-Sang. The Effect of Therapeutic Drug Monitoring on Safety and Efficacy of Voriconazole in Invasive Fungal Infections: A Randomized Controlled Trial. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol.55, no.8, 1080-1087.
Denning, D. W., Ribaud, P., Milpied, N., Caillot, D., Herbrecht, R., Thiel, E., Haas, A., Ruhnke, M., Lode, H.. Efficacy and Safety of Voriconazole in the Treatment of Acute Invasive Aspergillosis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol.34, no.5, 563-571.
Chu, Helen Y, Jain, Rupali, Xie, Hu, Pottinger, Paul, Fredricks, David N. Voriconazole therapeutic drug monitoring: retrospective cohort study of the relationship to clinical outcomes and adverse events. BMC infectious diseases, vol.13, 105-105.
Pascual, Andres, Csajka, Chantal, Buclin, Thierry, Bolay, Saskia, Bille, Jacques, Calandra, Thierry, Marchetti, Oscar. Challenging Recommended Oral and Intravenous Voriconazole Doses for Improved Efficacy and Safety: Population Pharmacokinetics-Based Analysis of Adult Patients With Invasive Fungal Infections. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol.55, no.3, 381-390.
Han, Kelong, Capitano, B., Bies, R., Potoski, B. A., Husain, S., Gilbert, S., Paterson, D. L., McCurry, K., Venkataramanan, R.. Bioavailability and Population Pharmacokinetics of Voriconazole in Lung Transplant Recipients. Antimicrobial agents and chemotherapy, vol.54, no.10, 4424-4431.
De Pauw, Ben, Walsh, Thomas J, Donnelly, J Peter, Stevens, David A, Edwards, John E, Calandra, Thierry, Pappas, Peter G, Maertens, Johan, Lortholary, Olivier, Kauffman, Carol A, Denning, David W, Patterson, Thomas F, Maschmeyer, Georg, Bille, Jacques, Dismukes, William E, Herbrecht, Raoul, Hope, William W, Kibbler, Christopher C, Kullberg, Bart Jan, Marr, Kieren A, Mu?oz, Patricia, Odds, Frank C, Perfect, John R, Restrepo, Angela, Ruhnke, Markus, Segal, Brahm H, Sobel, Jack D, Sorrell, Tania C, Viscoli, Claudio, Wingard, John R, Zaoutis, Theoklis, Bennett, John E. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group.. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol.46, no.12, 1813-1821.
Hamada, Yukihiro, Tokimatsu, Issei, Mikamo, Hiroshige, Kimura, Masao, Seki, Masafumi, Takakura, Shunji, Ohmagari, Norio, Takahashi, Yoshiko, Kasahara, Kei, Matsumoto, Kazuaki, Okada, Kenji, Igarashi, Masahiro, Kobayashi, Masahiro, Mochizuki, Takahiro, Nishi, Yoshifumi, Tanigawara, Yusuke, Kimura, Toshimi, Takesue, Yoshio. Practice guidelines for therapeutic drug monitoring of voriconazole: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy, vol.19, no.3, 381-392.
Dou, Y.H., Du, J.K., Liu, H.L., Shong, X.D.. The role of procalcitonin in the identification of invasive fungal infection-a systemic review and meta-analysis. Diagnostic microbiology and infectious disease, vol.76, no.4, 464-469.
Zhou, Wei, Li, Hongxing, Zhang, Yan, Huang, Mei, He, Qian, Li, Pei, Zhang, Fang, Shi, Yi, Su, Xin. Diagnostic Value of Galactomannan Antigen Test in Serum and Bronchoalveolar Lavage Fluid Samples from Patients with Nonneutropenic Invasive Pulmonary Aspergillosis. Journal of clinical microbiology, vol.55, no.7, 2153-2161.
Segal, Brahm H., Herbrecht, Raoul, Stevens, David A., Ostrosky‐Zeichner, Luis, Sobel, Jack, Viscoli, Claudio, Walsh, Thomas J., Maertens, Johan, Patterson, Thomas F., Perfect, John R., Dupont, Bertrand, Wingard, John R., Calandra, Thierry, Kauffman, Carol A., Graybill, John R., Baden, Lindsey R., Pappas, Peter G., Bennett, John E., Kontoyiannis, Dimitrios P., Cordonnier, Catherine, Viviani, Maria Anna, Bille, Jacques, Almyroudis, Nikolaos G., Wheat, L. Joseph, Graninger, Wolfgang, Bow, Eric J., Holland, Steven M., Kullberg, Bart‐Jan, Dismukes, William E., De Pauw, Ben E.. Defining Responses to Therapy and Study Outcomes in Clinical Trials of Invasive Fungal Diseases: Mycoses Study Group and European Organization for Research and Treatment of Cancer Consensus Criteria. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol.47, no.5, 674-683.
Snyder, L. D., Palmer, S. M.. Immune Mechanisms of Lung Allograft Rejection. Seminars in respiratory and critical care medicine, vol.27, no.5, 534-543.
Cornely, Oliver A., Koehler, Philipp, Arenz, Dorothee, C. Mellinghoff, Sibylle. EQUAL Aspergillosis Score 2018: An ECMM score derived from current guidelines to measure QUALity of the clinical management of invasive pulmonary aspergillosis. Mycoses, vol.61, no.11, 833-836.
※ AI-Helper는 부적절한 답변을 할 수 있습니다.