Bossù Gianluca, Di Sario Riccardo, Muratore Edoardo, Leardini Davide, Pession Andrea, Esposito Susanna, Masetti Riccardo
Department of Medicine and Surgery, Pediatric Clinic, University Hospital, University of Parma, 43126 Parma, Italy.
Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
Antibiotics (Basel). 2022 Sep 27;11(10):1316. doi: 10.3390/antibiotics11101316.
Invasive fungal diseases (IFDs) are a relevant cause of morbidity and mortality in children with cancer. Their correct prevention and management impact patients' outcomes. The aim of this review is to highlight the rationale and novel insights into antifungal prophylaxis and treatment in pediatric patients with oncological and hematological diseases. The literature analysis showed that IFDs represent a minority of cases in comparison to bacterial and viral infections, but their impact might be far more serious, especially when prolonged antifungal therapy or invasive surgical treatments are required to eradicate colonization. A personalized approach is recommended since pediatric patients with cancer often present with different complications and require tailored therapy. Moreover, while the infection rate does not seem to increase, in the near future, new therapeutic recommendations should be required in light of new epidemiological data on Candidemia due to resistant species. Finally, further studies on CAR-T treatment and other immunotherapies are needed in patients with unique needs and the risk of complications. Definitive guidelines on IFD treatment considering the evolving epidemiology of antifungal resistance, new therapeutic approaches in pediatric cancer, novel antifungal drugs and the importance of an appropriate antifungal stewardship are urgently needed.
侵袭性真菌病（IFD）是导致癌症患儿发病和死亡的一个相关原因。其正确的预防和管理会影响患者的预后。本综述的目的是强调针对患有肿瘤和血液疾病的儿科患者进行抗真菌预防和治疗的基本原理及新见解。文献分析表明，与细菌和病毒感染相比，IFD占病例的少数，但其影响可能更为严重，尤其是在需要长期抗真菌治疗或侵入性手术治疗以根除定植时。建议采用个性化方法，因为癌症患儿通常会出现不同的并发症，需要量身定制的治疗。此外，虽然感染率似乎没有增加，但鉴于耐菌株引起的念珠菌血症的新流行病学数据，在不久的将来需要新的治疗建议。最后，对于有特殊需求和并发症风险的患者，需要对嵌合抗原受体T细胞（CAR-T）治疗和其他免疫疗法进行进一步研究。迫切需要制定关于IFD治疗的明确指南，要考虑到抗真菌耐药性不断变化的流行病学、儿科癌症的新治疗方法、新型抗真菌药物以及适当的抗真菌管理的重要性。
