*

*

*

*

*

1100 spores/m3 (23 m diameter)

Alveolar macrophages TNF-MIP-1T-cell mediated acquired immunity T-helper (Th)-1interferon-interleukin (IL)-12 Th-2 IL-4 and IL-10

*

*

Corticosteroidsneutrophils, monocytes, lymphocytescorticosteroidsCOPD Invasive pulmonary aspergillosis (IPA) *

*Risk factorCOPD in combination with prolonged corticosteroid useHigh-dose systemic corticosteroids >3 weeks(e.g.prednisone equivalent >20mg/day)Chronic renal failure with RRTLiver cirrhosis/acute hepatic failureNear-drowningDiabetes mellitus

*Martin GS et al. N Engl J Med 2003;348:1546-54.10,319,41822

*2004:655

*(60)(n=156)(n=124)2801998;8(1):31-321980119976280156(60)124

*BSIBSI4(9%)crude mortality 39.2%,ICU47.1% (CID2004,39:309-17)

* NHDS, 19962003 100.000 *

1996-9922242,13,42000234,12001223,02002232,62003292,2

*70%-90%10%-20% (Martin GS,et al.N Engl J Med 2003,348:1546)IFD 42% 29% 14% 4% 3% 2% (Pappas PG, et al: Program and abstracts of 42nd IDSA. 2004:174)

*2010CHIF-NET82989%

* 1638 15.07% 292 2.65% 487 4.43% 2417 22.15%2010

*Wisplinghoff H, et al. Clin Infect Dis. 2004;39:309-317.N= 23,655Top 10 Etiologies of Nosocomial Blood Isolates (SCOPE): 1995-2002

(%)(%)31.320.720.225.49.433.99.039.25.622.44.827.64.338.73.926.71.727.41.334.0

*(n=1090)(n=269)(n=263)(n=140)(%)*ECMM :The European Confederation of Medical Mycology3. Tortorano MA et al. Eur J Clin Microbiol Infect Dis. 2004;23:317-22.ECMM*71997919991230

*()()()

*()

*592030546.7%60.1% 14.6%16.8%12.8%22.1%2004

2001(199)2002 (764)2003 (1032)2004 (3132)2005 (2882)2006 (3476)2007 (3805)2008 (3085)2009 (1940)46.760.154.262.159.457.757.960.659.816.615.716.815.216.116.015.515.614.622.112.813.413.214.415.316.113.214.56.50.82.80.91.51.41.21.91.91.52.01.91.61.81.21.51.82.73.00.50.40.50.80.70.70.81.26.68.610.97.06.88.47.86.96.5

*ARTEMIS (%)

*.2009;9(6):462-8

Species

1986

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2006

n

%

n

%

n

%

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461

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3539

66

8881

68.9

C. glabrata

147

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1977

12.9

C. tropicalis

141

2.6

1691

11.8

C. parapsilosis

274

3.9

366

2.5

C. krusei

85

1.7

306

2.1

C. guillicrmondii

67

1.1

51

0.8

*

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* 2001-2009 2001-2008

*1. 2.3. *2005-2009

1997-20002001-20042005-2007*%%%Global39,1520.971,0271.457,5981.42403.330491.489741.2Global5,63419.212,96315.910,34215.425880011.5237716.1Global2,9963.68,4964.57,0503.6811.26934.022454.4Global2,6332.57,7833.55,0053.6210779.12323.9Global1,20765.82,84077.52,23979.250906026081.5

*20012002200420050.9%(n=39152)1.0%(n=14268)1.5%(n=15147)1.4%(n=20576)1.6%(n=20988)(%)ARTEMIS Disk1997-20051.6%1.6%(n=18723)1997-20002003Paller MA et al. J Clin Microb.2007;45(6):1735-1745.19972005134205329CLSI

*%

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Clinical features

Mycology

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* - -(+)

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*Poikonen et al. BMC Infectious Diseases 2010, 10:312Figure 2 Use of fluconazole in daily defined doses(DDD) by region (tertiary-care center catchment area) in Finland,2000-2007

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HelsinkiTampereTurkuOuluKuopioAll five regions

200021.51419181619.5

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20032516.519.31916.723

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200426.517.517.518.817.523.7

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* 6010(%)(n=30)(n=30)10. Wolfgang G et al. J Infect 1993;26:133-146 20

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*(%)8. Pfaller M.A. Clin Microbiology Reviews,2006:435-44736/6552/7753/62135/142123/125/MICMIC

*

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*($1,000)*20021200514192*>400mg200mg/kg 400mg/kg 800mg/kg419224%Garey KW et al.Int J Antimicrob Agents. 2007;29(5):557-62. P=0.008835.546.9010203040506070

*11.148()*200120041574. Morrell M et al. Antimicrob Agents Chemother. 2005;49:3640-3645.12*33.1%P=0.169

*

800mg(12mg/kg)400mg(6mg/kg)(A-I)LFAmB3-5mg/kgAmB0.5-1mg/kg400mg(6mg/kg) bid200mg(3mg/kg) bid(A-I)(A-III) 14

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*44

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*10 10. Mark Abramowicz,et al. Medical Letter, 2005 February Vol. 3 (Issue 30)

400800mg/ 2 / 200mg100mg/1-3 400mg/8

*136-12 13.2004

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*macrophage inflammatory protein (MIP)-1****2009-2010CHIFNET1282989%

Data on file. **ECMM199791999127303038.5%

3. Tortorano MA et al. Eur J Clin Microbiol Infect Dis. 2004;23:317-22.******1295//MIC,S-DD200/400/800mg68%/72%/86%

8. Pfaller M.A. Clin Microbiology Reviews.2006;435-447.

**MICMIC50/86%/MIC6.2555

CLSI(The Clinical and Laboratory Standards Instite)

8. Pfaller M.A. Clin Microbiology Reviews,2006:435-447

**AUCAUC

AUCAUC

AUC

272003(L20030303006)**1996-1999 (n=248) 2.5 mg/kg bid (n=246) 400mg/ 8 (>=4) ()Axel Glasmacher, et al. J Antimicrob Chemother. 2006;57:317-25.**20021200514/1920This study was conducted at four general surgical/medical hospitals in the USA: The study period was from January 2002 to January 2005.A total of 192 non-neutropenic patients were identified.A retrospective cohort study was conducted of patients with candidaemia who were prescribed fluconazole at the onset of candidaemia or later. Hospital-related costs were compared based on time to initiation of fluconazole therapy and empirical fluconazole dose. Resource utilisation increased with inadequate fluconazole dosing in therapy.Total costs were lowest for patients started on fluconazole on the culture day with adequate doses ($35,45925,988) compared with all other patients ($52,15853,492) (P = 0.0088).Garey KW et al.Int J Antimicrob Agents. 2007;29(5):557-62.

**200112004121571211.1%1233.1%(P=0.169)

4. Morrell M et al. Antimicrob Agents Chemother. 2005;49:3640-3645.

**1998-2000734vs5431vs56(P506-12