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침습성 진균 감염증과 약제 내성

Invasive Fungal Infections in the Era of Antifungal Resistance

정숙인|김어진
대한내과학회 (The Korean Association Of Internal Medicine)|2015.05|대한내과학회지 (The Korean Journal of Medicine)|제88권 제5호|pp. 518-524|DOI http://dx.doi.org/10.3904/kjm.2015.88.5.518

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참고문헌

키워드

Resistance내성항진균제Invasive fungal infection침습성진균감염증Antifuangals
주제분류내과학

초록

1956년에 개발된 polyene계열의 항진균제인 amphotericin B에서 1990년대에부터 사용된 1세대 및 2세대 triazole 항진균제와 2000년대의 echinocandin 항진균제까지 20세기의 항진균제의 발전은 침습적 진균감염증의 치료에 있어서 커다란 성과를 거두었다. 그럼에도 불구하고 침습적 진균 감염증은 여전히 높은 이환율과 사망률을 일으키는 주요한 원내감염균이며 국내에서도 입원기간의 연장 및 막대한 의료비 지출을 유발하는 요인이다[1]. 일반적인 세균의 높은 항생제내성에 비해서 진균은 항진균제에 내성을 띄는 경우가 드물지만, 1990년대 후천성면역결핍증 환자에서 분리된 칸디다균주에서 높은 fluconazole 내성이 보고된 이래 항진균제 내성이 지속적으로 보고되고 있다[2]. 더욱이 최근 항진균제예방요법, 항진균제의 사용의 증가 및 환경적 요인 등에 의해 항진균제에 대한 내성 또한 점차 늘어가고 있으며 이는임상적으로는 치료의 실패 및 사망률을 증가로 이어지고 있다[3,4].

Abstract

Invasive fungal diseases are an important cause of morbidity and mortality in both immunocompromised and immunocompetent patients. The recent introduction of new antifungal agents seemed to open a new era for the treatment of invasive fungal infections. However, widespread use of prophylactic and therapeutic antifungal agents has lead to the emergence of antifungal resistance and potentially compromises their clinical utility. By understanding the mechanisms of drug resistance, new strategies can be utilized to minimize the emergence of drug resistance and to promote the development of innovative therapeutic approaches. In the meantime, close monitoring of antifungal resistance and its evolution is warranted in a clinical setting given the limited repertoire of antifungal drugs.

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