Popova Marina, Rogacheva Yuliya
RM Gorbacheva Research Institute, Pavlov University, Ulitsa Rentgena, 12, St. Petersburg, 197022, Russia.
J Infect Public Health. 2025 Aug;18(8):102804. doi: 10.1016/j.jiph.2025.102804. Epub 2025 May 6.
Invasive fungal diseases (IFD) are severe complications in patients with hematological malignancies, worsening prognosis, and increasing mortality. Despite extensive research, epidemiological data often lack temporal systematization, hindering interpretation and practical application. The objective was to assess the incidence and etiology of IFDs in oncohematological patients across different therapeutic groups using published studies.
A systematic search was conducted in PubMed (Medline), Embase, and Google Scholar. Meta-analyses using primarily random-effects models were performed to estimate IFD incidence, overall etiological structure (proportions of major genera like Aspergillus, Candida, and rare pathogens), and analyze temporal trends (pre- vs. post-2010).
Incidence analysis included 34 publications (47 cohorts; 91,151 participants); etiology analysis included 35 cohorts (4427 isolates). Pooled IFD incidence was significantly higher in allo-HSCT recipients (9.96 %, 95 % CI 8.24-11.83 %) compared to chemotherapy (5.22 %, 95 % CI 3.96-6.65 %) and auto-HSCT (3.39 %, 95 % CI 1.56-5.83 %). Overall, Aspergillus (44.8 %) and Candida (34.1 %) dominated IFD etiology. A numerical shift occurred over time, with Candida proportion (48.6 %) surpassing Aspergillus (38.0 %) after 2010, reversing the pattern seen before 2010 (Candida 30.0 %, Aspergillus 47.8 %). Rare pathogens collectively accounted for ∼12.9 % pre-2010 and ∼8.8 % post-2010. Despite these numerical shifts, no statistically significant overall differences in IFD incidence or the proportions of major/rare pathogen groups were found between the pre- and post-2010 periods based on subgroup difference tests (p > 0.05). Etiology varied significantly by treatment.
This comprehensive meta-analysis reveals significant variability in IFD incidence and etiology based on treatment modality, with allo-HSCT conferring the highest risk. While numerical shifts in pathogen distribution occurred over time, statistically significant overall temporal trends were not detected in this dataset for major or rare pathogens. High study heterogeneity is a key limitation. The findings underscore the need for risk-stratified prophylaxis and diagnostics, informing antifungal stewardship strategies tailored to treatment settings.
侵袭性真菌病（IFD）是血液系统恶性肿瘤患者的严重并发症，会使预后恶化并增加死亡率。尽管进行了广泛研究，但流行病学数据往往缺乏时间上的系统性，阻碍了其解读和实际应用。目的是利用已发表的研究评估不同治疗组的肿瘤血液学患者中IFD的发病率和病因。
在PubMed（Medline）、Embase和谷歌学术中进行了系统检索。主要使用随机效应模型进行荟萃分析，以估计IFD发病率、总体病因结构（曲霉菌、念珠菌等主要属以及罕见病原体的比例），并分析时间趋势（2010年前与2010年后）。
发病率分析纳入34篇出版物（47个队列；91151名参与者）；病因分析纳入35个队列（4427株分离株）。与化疗（5.22%，95%CI 3.96 - 6.65%）和自体造血干细胞移植（auto - HSCT，3.39%，95%CI 1.56 - 5.83%）相比，异基因造血干细胞移植（allo - HSCT）受者的合并IFD发病率显著更高（9.96%，95%CI 8.24 - 11.83%）。总体而言，曲霉菌（44.8%）和念珠菌（34.1%）在IFD病因中占主导地位。随着时间推移出现了数值变化，2010年后念珠菌比例（48.6%）超过曲霉菌（38.0%），扭转了2010年前的模式（念珠菌30.0%，曲霉菌47.8%）。2010年前罕见病原体合计占约12.9%，2010年后占约8.8%。尽管有这些数值变化，但根据亚组差异检验，2010年前和2010年后期间在IFD发病率或主要/罕见病原体组比例方面未发现总体统计学显著差异（p>0.05）。病因因治疗方式而异。
这项全面的荟萃分析揭示了基于治疗方式的IFD发病率和病因存在显著差异，allo - HSCT的风险最高。虽然病原体分布随时间发生了数值变化，但在该数据集中未检测到主要或罕见病原体有总体统计学显著的时间趋势。研究异质性高是一个关键限制因素。这些发现强调了进行风险分层预防和诊断的必要性，为针对治疗环境量身定制的抗真菌管理策略提供依据。
