Wang Xinyin, You Yanjing, Chen Shuyang, Wang Peiyu, Zeng Shengyuan, Zhuang Liying, Wang Meng, Lai Guoxiang, Yu Zongyang, Yu Guoqing, Wen Wen
Department of Pulmonary and Critical Care Medicine, Fuzong Clinical Medical College of Fujian Medical University, Dongfang Hospital of Xiamen University, School of Medicine, Xiamen University, 900th Hospital of PLA Joint Logistic Support Force, Fuzhou, Fujian, China.
Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
Front Med (Lausanne). 2025 Apr 28;12:1565071. doi: 10.3389/fmed.2025.1565071. eCollection 2025.
Treating severe pneumonia caused by multiple pathogens in immunocompromised hosts (ICHs) presents significant challenges. Isavuconazole (ISA), a next-generation triazole antifungal agent, has shown promise in managing fungal infections. However, clinical evidence regarding its efficacy in cases of complex infections involving multiple pathogens in ICHs remains limited.
This study describes a case series of three ICHs diagnosed with severe pneumonia, including invasive aspergillosis (IA). All three patients received ISA-based personalized antimicrobial regimens. Alleviation of symptoms was observed in all patients following antimicrobial treatment, with notable absorption of pulmonary lesions and no significant hepatorenal toxic side effects, with no recurrence observed.
ICHs are highly susceptible to fungal infections, and the severity of their condition can escalate dramatically, with a significant risk of mortality, when severe pneumonia caused by multiple pathogens occurs concurrently. A stepwise treatment strategy, which balances the use between immunosuppressant and effective antimicrobial treatment, is crucial. The selection of appropriate drugs should account for potential adverse drug reactions (ADRs). In this case series, ISA exhibited robust efficacy in treating IA with minimal ADRs. Therefore, ISA represents a valuable option for managing severe pneumonia in ICHs, particularly in the context of IA and co-infections caused by multiple pathogens.
治疗免疫功能低下宿主（ICHs）中由多种病原体引起的重症肺炎面临重大挑战。艾沙康唑（ISA）是一种新一代三唑类抗真菌药物，在管理真菌感染方面已显示出前景。然而，关于其在ICHs中涉及多种病原体的复杂感染病例中的疗效的临床证据仍然有限。
本研究描述了一系列三例被诊断为重症肺炎的ICHs病例，包括侵袭性曲霉病（IA）。所有三名患者均接受了以ISA为基础的个性化抗菌治疗方案。抗菌治疗后所有患者症状均有缓解，肺部病变明显吸收，且无明显肝肾毒性副作用，无复发情况。
ICHs对真菌感染高度易感，当同时发生由多种病原体引起的重症肺炎时，其病情严重程度可急剧升级，存在显著的死亡风险。一种平衡免疫抑制剂使用与有效抗菌治疗的逐步治疗策略至关重要。选择合适的药物应考虑潜在的药物不良反应（ADR）。在本病例系列中，ISA在治疗IA时显示出强大的疗效且ADR最小。因此，ISA是管理ICHs中重症肺炎的一个有价值的选择，特别是在IA和由多种病原体引起的合并感染的情况下。
