SUCCESSFUL CHEMOPROPHYLAXIS FOR Pneumocystis carinii PNEUMONITIS (PCP)

Abstract

Fungal infections constitute an ever-growing healthcare problem worldwide. Invasive fungal disease (IFD) is a leading cause of morbidity and mortality in severely immunocompromised individuals, including a variety of critically ill patients. High-risk conditions for IFD include hematologic malignancies, hematopoietic stem cell or solid organ transplantations, primary or acquired immunodefi ciencies such as AIDS, long-term treatment at intensive care units, preterm birth, long-term immunosuppressive therapy, broad-spectrum antibiotic therapy, and long presence of central indwelling catheters. Despite the availability of a number of potent antifungal drugs, successful treatment of IFD is often hampered by the limited diagnostic options which neither permit rapid and reliable identifi cation of systemic, acute, or latent fungal infections nor facilitate assessment of host susceptibility. The resulting delay in the onset of antifungal therapy is an important factor contributing to the poor overall clinical outcome of IFD. Moreover, the widespread use of prophylactic or empirical treatment without fi rm evidence of IFD leads to a high rate of overtreatment associated with considerable toxic side effects, and broad-spectrum antimycotic therapy administered against unidentifi ed fungal pathogens can promote the evolution of clinical drug resistance.