认识到真菌感染的全球负担日益增加,世界卫生组织建立了制定真菌病原体优先清单(FPPL)的程序。在这次系统审查中,我们旨在评估由烟曲霉引起的侵袭性感染的流行病学和影响,以告知首次FPPL.预先规定的死亡率标准,住院护理,并发症和后遗症,抗真菌药敏,危险因素,可预防性,年发病率,全球分销,和出现被用来搜索2016年1月1日至2021年6月10日之间的相关文章。总的来说,49项研究符合纳入条件。唑类抗真菌药物敏感性因地理区域而异。荷兰报告伏立康唑敏感率为22.2%,而在巴西,韩国,印度,中国,和英国,伏立康唑敏感率为76%,94.7%,96.9%,98.6%,99.7%,分别。交叉抗性是常见的85%,92.8%,100%的耐伏立康唑的烟曲霉分离株也对伊曲康唑耐药,泊沙康唑,和伊沙武康唑,分别。急性白血病患者侵袭性曲霉病(IA)的发病率估计为5.84/100。IA病例的6周死亡率为31%至36%。唑抵抗和恶性血液病是不良预后因素。伏立康唑耐药的12周死亡率显着高于伏立康唑敏感的IA病例(12/22[54.5%]vs.27/88[30.7%];P=.035),与患有IA的实体恶性肿瘤病例相比,患有IA的血液学患者的死亡率明显更高(65/217[30%]vs.14/78[18%];P=.04)。需要精心设计的将实验室和临床数据联系起来的监测研究,以更好地为未来的FPPL提供信息。
Recognizing the growing global burden of fungal infections, the World Health Organization established a process to develop a priority list of fungal pathogens (FPPL). In this systematic
review, we aimed to evaluate the
epidemiology and impact of invasive infections caused by Aspergillus fumigatus to inform the first FPPL. The pre-specified criteria of mortality, inpatient care, complications and sequelae, antifungal susceptibility, risk factors, preventability, annual incidence, global distribution, and emergence were used to search for relevant articles between 1 January 2016 and 10 June 2021. Overall, 49 studies were eligible for inclusion. Azole antifungal susceptibility varied according to geographical regions. Voriconazole susceptibility rates of 22.2% were reported from the Netherlands, whereas in Brazil, Korea, India, China, and the UK, voriconazole susceptibility rates were 76%, 94.7%, 96.9%, 98.6%, and 99.7%, respectively. Cross-resistance was common with 85%, 92.8%, and 100% of voriconazole-resistant A. fumigatus isolates also resistant to itraconazole, posaconazole, and isavuconazole, respectively. The incidence of invasive aspergillosis (IA) in patients with acute leukemia was estimated at 5.84/100 patients. Six-week mortality rates in IA cases ranged from 31% to 36%. Azole resistance and hematological malignancy were poor prognostic factors. Twelve-week mortality rates were significantly higher in voriconazole-resistant than in voriconazole-susceptible IA cases (12/22 [54.5%] vs. 27/88 [30.7%]; P = .035), and hematology patients with IA had significantly higher mortality rates compared with solid-malignancy cases who had IA (65/217 [30%] vs. 14/78 [18%]; P = .04). Carefully designed surveillance studies linking laboratory and clinical data are required to better inform future FPPL.