Portillo Vera, Neofytos Dionysios
Division of Infectious Diseases, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
Internal Medecine, Ensemble Hospitalier de la Côte, Hôpital de Moges, Chemin de la Crêt 2, Morges, Vaud, Switzerland.
Mycopathologia. 2024 Jun 13;189(4):56. doi: 10.1007/s11046-024-00864-z.
The incidence of breakthrough mold infections (bIMI) has been increasing, due to routine administration of broad-spectrum antifungal prophylaxis and an increasing pool of high-risk patient populations, with fungi more challenging to treat, resulting in a sustained high mortality, despite progress in diagnostic and therapeutic options. Pharmacokinetics of antifungal drugs, fungal, and host, including genetic, factors play a role in the emergence of bIMI. Suggested therapeutic approaches have included change of antifungal class treatment, with amphotericin-B products predominating as first-line empirical treatment and switching from one broad-spectrum azole to another remaining the most frequently used treatment modalities. Future perspectives include determining individual susceptibility to IMI to tailor prophylaxis and treatment strategies, improved diagnostic tests, and the introduction of new antifungal agents that may reduce morbidity and mortality caused by bIMI.
突破性霉菌感染（bIMI）的发生率一直在上升，这是由于广谱抗真菌预防药物的常规使用以及高危患者群体的不断增加，真菌的治疗更具挑战性，尽管在诊断和治疗选择方面取得了进展，但仍导致持续的高死亡率。抗真菌药物、真菌和宿主的药代动力学，包括遗传因素，在bIMI的出现中起作用。建议的治疗方法包括改变抗真菌药物类别治疗，两性霉素B产品作为一线经验性治疗占主导地位，从一种广谱唑类药物转换为另一种仍然是最常用的治疗方式。未来的前景包括确定个体对侵袭性霉菌感染（IMI）的易感性，以定制预防和治疗策略，改进诊断测试，以及引入可能降低bIMI所致发病率和死亡率的新型抗真菌药物。
