Lass-Flörl Cornelia, Cuenca-Estrella Manuel
Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schöpfstraße 41, 6020 Innsbruck, Austria.
Department of Mycology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo Km 2, Majadahonda, Madrid, Spain.
J Antimicrob Chemother. 2017 Mar 1;72(suppl_1):i5-i11. doi: 10.1093/jac/dkx028.
Although a wide variety of pathogens are associated with invasive mould diseases, Aspergillus spp. have historically been one of the most common causative organisms. Most invasive mould infections are caused by members of the Aspergillus fumigatus species complex and an emerging issue is the occurrence of azole resistance in A. fumigatus, with resistance to amphotericin B documented in other Aspergillus spp. The epidemiology of invasive fungal disease has shifted in recent years as non-A. fumigatus Aspergillus spp. and other moulds have become progressively more important, although there are no consolidated data on the prevalence of less common species of moulds. The incidence of mucormycosis may have been underestimated, which is a potential concern since species belonging to the order Mucorales are more resistant to antifungal agents than Aspergillus spp. All species of Mucorales are unaffected by voriconazole and most show moderate resistance in vitro to echinocandins. Fusarium spp. may be the second most common nosocomial fungal pathogen after Aspergillus in some tertiary hospitals, and show a susceptibility profile marked by a higher level of resistance than that of Aspergillus spp. Recently, Scedosporium aurantiacum has been reported as an emerging opportunistic pathogen, against which voriconazole is the most active antifungal agent. Other mould species can infect humans, although invasive fungal disease occurs less frequently. Since uncommon mould species exhibit individual susceptibility profiles and require tailored clinical management, accurate classification at species level of the aetiological agent in any invasive fungal disease should be regarded as the standard of care.
尽管多种病原体与侵袭性霉菌病相关，但曲霉属真菌历来是最常见的致病生物之一。大多数侵袭性霉菌感染由烟曲霉复合种的成员引起，一个新出现的问题是烟曲霉对唑类药物产生耐药性，其他曲霉属真菌也有对两性霉素B耐药的记录。近年来，侵袭性真菌病的流行病学发生了变化，因为非烟曲霉属曲霉和其他霉菌变得越来越重要，尽管关于较不常见霉菌种类的患病率尚无综合数据。毛霉病的发病率可能被低估了，这是一个潜在的问题，因为毛霉目真菌比曲霉属真菌对抗真菌药物更具耐药性。所有毛霉目真菌对伏立康唑均无反应，且大多数在体外对棘白菌素表现出中度耐药。在一些三级医院，镰刀菌属可能是仅次于曲霉的第二常见的医院内真菌病原体，其药敏谱显示出比曲霉属更高的耐药水平。最近，桔青霉被报道为一种新出现的机会性病原体，伏立康唑是针对它最有效的抗真菌药物。其他霉菌种类也可感染人类，尽管侵袭性真菌病的发生频率较低。由于不常见的霉菌种类表现出个体药敏谱，需要进行针对性的临床管理，因此在任何侵袭性真菌病中，对病原体进行准确的种水平分类应被视为标准治疗。
