Giannella Maddalena, Lanternier Fanny, Dellière Sarah, Groll Andreas H, Mueller Nicolas J, Alastruey-Izquierdo Ana, Slavin Monica A
Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; European Society of Clinical Microbiology and Infectious Diseases Study Group for Infections in Compromised Hosts (ESCICH/ESCMID), Basel, Switzerland.
Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland; Infectious Diseases Department, Necker-Enfants Malades Hospital, Paris Cité University, AP-HP, Paris, France; Mycology Department, Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Paris, France.
Clin Microbiol Infect. 2025 Jan;31(1):29-36. doi: 10.1016/j.cmi.2024.08.006. Epub 2024 Aug 12.
Invasive fungal disease (IFD) causes morbidity and mortality in immunocompromised hosts (ICHs). Based on increasing recognition of the impact of IFD on human disease, a recent WHO priority list identified key areas of need.
This review examines changes in the epidemiology of IFD, in particular the emergence of antifungal-resistant pathogens and the current availability of rapid diagnostic tests and antifungal treatment options.
Literature between 2000 and January 2024 regarding fungal epidemiology, diagnostic tests, antifungal resistance, emerging fungal pathogens, and novel antifungal agents in both adult and paediatric ICH were reviewed.
We describe the changing epidemiology and continued burden and mortality of IFD in ICH. Furthermore, we discuss the emergence of antifungal-resistant organisms driven by new immunosuppressed populations, climate change, and antifungal exposure in the individual and environment. We highlight novel antifungal agents and how they will address current unmet needs.
The changing epidemiology and increased population at risk for IFD, lack of recognition or quantification of risks for IFD with new therapies, current gaps in the availability of rapid diagnostic tests, and the imminent availability of novel antifungals with distinct spectra of activity argue for improved availability of and access to rapid diagnostics, antifungal stewardship programmes, and global access to antifungal agents.
侵袭性真菌病（IFD）在免疫功能低下宿主（ICH）中可导致发病和死亡。基于对IFD对人类疾病影响的认识不断提高，世界卫生组织最近的一份优先事项清单确定了关键需求领域。
本综述探讨IFD流行病学的变化，特别是耐真菌病原体的出现以及快速诊断测试和抗真菌治疗选择的当前可得情况。
对2000年至2024年1月间关于成人和儿童ICH中真菌流行病学、诊断测试、抗真菌耐药性、新出现的真菌病原体和新型抗真菌药物的文献进行了综述。
我们描述了ICH中IFD不断变化的流行病学以及持续的负担和死亡率。此外，我们讨论了由新的免疫抑制人群、气候变化以及个体和环境中的抗真菌暴露所驱动的耐抗真菌生物的出现。我们强调了新型抗真菌药物以及它们将如何满足当前未满足的需求。
IFD不断变化的流行病学以及IFD风险人群的增加、新疗法对IFD风险缺乏认识或量化、快速诊断测试当前可用性方面的差距，以及即将出现具有不同活性谱的新型抗真菌药物，都表明需要提高快速诊断的可得性和可及性、抗真菌管理计划以及全球对抗真菌药物的可及性。
