Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press32810.17650/2686-9594-2019-9-4-11-20LITERATURE REVIEWОБЗОР ЛИТЕРАТУРЫCriteria for the administration of systemic antimicotic therapy in surgical intensive care units (literature review)Критерии назначения системной антимикотической терапии в хирургическом отделении реанимации и интенсивной терапии (обзор литературы)BelotserkovskiyB. Z.БелоцерковскийБ. З.
Russian Federation

Department of Anesthesiology and Intensive Care

1 Ostrovityanova St., Moscow 117997

Белоцерковский  Борис Зиновьевич. Кафедра анестезиологии и реаниматологии 

117997 Москва, ул. Островитянова, 1 

belotserkovskii@mail.ruGelfandE. B.ГельфандЕ. Б.
Russian Federation

117997 Москва, ул. Островитянова, 1

BykovA. O.БыковА. О.
Russian Federation

117997 Москва, ул. Островитянова, 1

MamontovaO. A.МамонтоваО. А.
Russian Federation

117997 Москва, ул. Островитянова, 1

ProtsenkoD. N.ПроценкоД. Н.
Russian Federation

117997 Москва, ул. Островитянова, 1

N. I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaФДПО ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава России131120199411201211201912112019Copyright ©; 2019, ABV-pressCopyright ©; 2019, АБВ-пресс2019ABV-pressАБВ-прессhttps://onco-surgery.info/jour/about/editorialPolicieshttps://onco-surgery.info/jour/article/view/328

This review focuses on the practical aspects of prevention and treatment of fungal infections in surgical patients. It covers epidemiology and risk factors for invasive candidiasis, updates on the etiological structure of fungal infections in patients in critical conditions, and provides the information on drug sensitivity of Candida species. The authors discuss the limitations of cultural and non-cultural diagnostic methods used in invasive candidiasis, emphasizing the importance of analyzing the existing risk factors in combination with a comprehensive assessment of clinical and laboratory data for timely initiation of adequate antifungal therapy. The review provides a brief description of currently available antimicotics, including polyenes, triazoles, and echinocandins. It also describes the benefits of anidulafungin, which does not interact with other drugs and has no negative effect on the liver and kidney. The article also covers indications for antifungal agents in surgical intensive care units in accordance with international and Russian guidelines. A cohort of patients with abdominal diseases requiring preventive and empirical treatment with antimicotics is described. In additions to that, the manuscript contains a rationale for the use of echinocandins in targeted therapy of invasive candidiasis.

Данный обзор посвящен практическим аспектам антифунгальной профилактики и терапии у хирургических пациентов. Подробно рассматриваются эпидемиология и факторы риска развития инвазивного кандидоза, приведены актуальные данные по этиологической структуре грибковых инфекций у пациентов в критических состояниях, отражены сведения по чувствительности грибов рода Candida к антимикотикам. Авторы обзора отмечают ограничения культуральных и некультуральных методов диагностики инвазивного кандидоза, подчеркивая важность анализа имеющихся у пациента факторов риска в сочетании с комплексной оценкой клинических и лабораторных данных для своевременного назначения адекватного антифунгального лечения. В обзоре дана краткая характеристика доступных в настоящее время антимикотиков: полиенов, триазолов и эхинокандинов, приведены доказательные данные о преимуществах анидулафунгина, не имеющего лекарственных взаимодействий и не оказывающего отрицательного влияния на функции печени и почек. В соответствии с современными международными и отечественными рекомендациями рассмотрены показания для назначения противогрибковых препаратов в отделениях реанимации хирургического профиля. Охарактеризована когорта пациентов с заболеваниями органов брюшной полости, нуждающихся в профилактическом и эмпирическом назначении антимикотиков, обоснована необходимость применения эхинокандинов для целенаправленной терапии инвазивного кандидоза.

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