Infectious Diseases Service and Institute of Microbiology, University Hospital of Lausanne and Lausanne University, Lausanne, Switzerland
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Antimicrob Agents Chemother. 2019 Oct 22;63(11). doi: 10.1128/AAC.01244-19. Print 2019 Nov.
While spp. remain the major cause of invasive mold infections in hematologic cancer patients and transplant recipients, other opportunistic molds, such as , , and spp. are increasingly encountered in an expanding population of patients with severe and prolonged immunosuppression. High potential for tissue invasion and dissemination, resistance to multiple antifungals and high mortality rates are hallmarks of these non- invasive mold infections (NAIMIs). Assessment of drug efficacy is particularly difficult in the complex treatment scenarios of NAIMIs. Specifically, correlation between susceptibility and responses to antifungals is hard to assess, in view of the multiple, frequently interrelated factors influencing outcomes, such as pharmacokinetic/pharmacodynamic parameters determining drug availability at the site of infection, the net state of immune suppression, delay in diagnosis, or surgical debulking of infectious foci. Our current therapeutic approach of NAIMIs should evolve toward a better integration of the dynamic interactions between the pathogen, the drug and the host. Innovative concepts of experimental research may consist in manipulating the host immune system to induce a specific antifungal response or targeted drug delivery. In this review, we discuss the challenges in the management of NAIMIs and provide an update about the latest advances in diagnostic and therapeutic approaches.
虽然 spp. 仍然是血液系统恶性肿瘤患者和移植受者侵袭性真菌感染的主要原因，但其他机会性霉菌，如 、 、 和 spp.，在严重和长期免疫抑制的患者群体中越来越常见。这些非侵袭性霉菌感染（NAIMIs）具有很强的组织侵袭和播散能力，对多种抗真菌药物具有耐药性，死亡率高，是其特征。在 NAIMIs 的复杂治疗方案中，评估药物疗效尤其困难。具体而言，鉴于影响结果的多种、经常相互关联的因素，如决定感染部位药物可用性的药代动力学/药效学参数、免疫抑制的净状态、诊断延迟或感染灶的手术去负荷，抗真菌药物敏感性与 反应之间的相关性难以评估。我们目前对 NAIMIs 的治疗方法应朝着更好地整合病原体、药物和宿主之间的动态相互作用发展。实验研究的创新概念可能包括操纵宿主免疫系统以诱导特定的抗真菌反应或靶向药物递送。在这篇综述中，我们讨论了管理 NAIMIs 的挑战，并提供了诊断和治疗方法最新进展的更新。
