背景:侵袭性真菌病(IFD)在免疫受损宿主(ICH)中引起发病率和死亡率。基于人们越来越认识到IFD对人类疾病的影响,世卫组织最近的一份优先事项清单确定了关键的需要领域。
目的:这篇综述考察了IFD流行病学的变化,特别是抗真菌耐药病原体的出现以及目前快速诊断测试和抗真菌治疗方案的可用性。
方法:2000年至2024年1月有关真菌流行病学的文献,诊断测试,抗真菌耐药性,综述了成人和儿童免疫功能低下宿主(ICH)中新兴的真菌病原体和新型抗真菌药物。
背景:我们描述了ICH中IFD的流行病学变化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群体驱动的抗真菌抗性生物的出现,气候变化和个体和环境中的抗真菌暴露。我们重点介绍了新型抗真菌剂以及它们将如何满足当前未满足的需求。
结论:流行病学的变化和IFD风险人群的增加,缺乏对新疗法的IFD风险的认识或量化,目前在快速诊断测试的可用性和具有不同活性谱的新型抗真菌药物的可用性方面存在差距,这表明提高了快速诊断的可用性和可获得性,抗真菌管理计划和全球抗真菌药物的获取。
BACKGROUND: Invasive fungal disease (IFD) causes morbidity and mortality in immunocompromised hosts (ICH). Based on increasing recognition of the impact of IFD on human disease, a recent WHO priority list identified key areas of need.
OBJECTIVE: This review examines changes in epidemiology of IFD, in particular emergence of antifungal resistant pathogens and current availability of rapid diagnostic tests and antifungal treatment options.
METHODS: Literature between 2000 and January 2024 regarding fungal epidemiology, diagnostic test, antifungal resistance, emerging fungal pathogens and novel antifungal agents in both adult and pediatric immunocompromised hosts (ICH) was reviewed.
BACKGROUND: We describe the changing epidemiology and continued burden and mortality of IFD in ICH. Further 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.
CONCLUSIONS: The changing epidemiology and increased population at risk for IFD, lack of recognition of 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 programs and global of access to antifungal agents.