Revista Iberoamericana De Micologia最新文献_第2页

Comparative analysis of the nephrotoxicity of liposomal amphotericin B and amphotericin B lipid complex in hematological cancer patients: A multicenter retrospective study 两性霉素B脂质体和两性霉素B脂质复合物对血液病患者肾毒性的比较分析：一项多中心回顾性研究。

IF 1.6 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-04-01 DOI: 10.1016/j.riam.2025.04.003

Susanne Edinger , Edson Abdala , Umran Şumeyse Ertürk , Serhat Çelik , Leylagül Kaynar , Ricardo Rabagliati , Hamid Badali , Ali Amanati , Alexis Manuel Holguin Ruiz , Joseph Meletiadis , Maria Stamouli , Jessica Fernandes Ramos , Alexandre Vargas Schwarzbold , Juan Pablo Caeiro , Guillermo N. Giordano , Maria N. Gamaletsou , Leonardo Filipetto Ferrari , Joao Paulo Telles , Felipe Francisco Tuon , Luiz Cesar Guarita-Souza

Background

The incidence rates of acute kidney injury (AKI) associated with amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AMB) are inconsistent across studies.

Aims

This study aimed to assess the AKI incidence rates in the largest cohort of patients undergoing ABLC and L-AMB treatment for invasive fungal diseases (IFD) in individuals with hematological cancers.

Methods

This was a multicenter, international, retrospective cohort study involving patients treated with either L-AMB or ABLC for IFD. All patients had a diagnosed malignant hematological disease. Various clinical and epidemiological variables were examined, including the concurrent use of nephrotoxic drugs. The primary outcome was the incidence of AKI.

Results

A total of 637 patients were included in the study, with 294 patients in the ABLC group and 343 patients in the L-AMB group. The most common diagnosis was acute leukemia (56%), followed by lymphoma (22%). The predominant classification of IFD was probable (43%). ABLC was associated with an increased likelihood of inducing grade 1 and 2 nephrotoxicity compared to L-AMB (p < 0.001). Multivariate analysis identified age, vancomycin, and polymyxin use as independent risk factors for AKI. However, serum creatinine levels returned to baseline in 95.3% of patients.

Conclusion

Nephrotoxicity associated with L-AMB was lower than that associated with ABLC in patients with hematological cancer. Most AKI cases were mild to moderate and did not have significant short-term impact.

背景：与两性霉素B脂质复合物（ABLC）和两性霉素B脂质体（L-AMB）相关的急性肾损伤（AKI）发生率在研究中不一致。目的：本研究旨在评估血液病患者中接受ABLC和L-AMB治疗侵袭性真菌病（IFD）的最大队列患者的AKI发病率。方法：这是一项多中心、国际、回顾性队列研究，涉及使用L-AMB或ABLC治疗IFD的患者。所有患者均确诊为恶性血液病。检查了各种临床和流行病学变量，包括同时使用肾毒性药物。主要终点是AKI的发生率。结果：共纳入637例患者，其中ABLC组294例，L-AMB组343例。最常见的诊断是急性白血病（56%），其次是淋巴瘤（22%）。IFD的主要分类是可能的（43%）。与L-AMB相比，ABLC与诱导1级和2级肾毒性的可能性增加相关(结论：血液癌患者与L-AMB相关的肾毒性低于与ABLC相关的肾毒性。大多数AKI病例为轻度至中度，没有显著的短期影响。

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引用次数: 0

From 2012 ESCMID to global 2025 ECMM/ISHAM/ASM Candida guidelines: What are the key differences & practical implications? 从2012年ESCMID到2025年ECMM/ISHAM/ASM假丝达指南：主要差异和实际意义是什么？

IF 1.6 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-04-01 DOI: 10.1016/j.riam.2025.05.002

Cornelia Lass-Flörl

The unity of the global 2025 ECMM/ISHAM/ASM Candida guideline (global Candida 2025 guideline) means a practitioner can find all important topics in one document, whereas in 2012 one had to consult multiple papers for each subgroup. The global Candida 2025 guideline retains echinocandins as the first-line treatment for invasive candidiasis while incorporating new agents – such as rezafungin for once-weekly dosing and novel oral options for resistant infections – to offer more personalized, susceptibility-guided therapy. They also recommend an earlier intravenous-to-oral step-down in stable non-neutropenic patients, and emphasize the need for prompt source control. Additionally, there is a stronger focus on managing emerging resistance (notably with Candida auris and azole-resistant Candida parapsilosis) and tailoring prophylaxis and treatment strategies to local epidemiology and special patient populations. It provides detailed, evidence-graded recommendations using the GRADE system, with explicit sections on emerging pathogens, resistance, antifungal stewardship, and infection control. The global Candida 2025 guideline incorporates broader public health considerations and guidance on resource-limited settings.

全球2025 ECMM/ISHAM/ASM念珠菌指南（全球念珠菌2025指南）的统一意味着从业者可以在一份文件中找到所有重要的主题，而在2012年，人们必须为每个子组查阅多篇论文。全球念珠菌2025指南保留了刺珠菌素作为侵袭性念珠菌病的一线治疗方法，同时纳入了新的药物——例如每周一次给药的rezafungin和治疗耐药感染的新型口服药物——以提供更加个性化的、以药物敏感性为导向的治疗。他们还建议在稳定的非中性粒细胞减少症患者中早期静脉到口服降压，并强调需要及时进行源头控制。此外，还更加注重管理新出现的耐药性（特别是耳念珠菌和耐唑假丝菌病），并根据当地流行病学和特殊患者群体制定预防和治疗策略。它使用GRADE系统提供了详细的证据分级建议，并明确介绍了新出现的病原体、耐药性、抗真菌管理和感染控制。《念珠菌2025》全球指南纳入了更广泛的公共卫生考虑和对资源有限环境的指导。

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引用次数: 0

Shift in Candida species causing candidemia: A seven-year study from a university hospital and evaluation of the rise of Candida parapsilosis sensu stricto 引起念珠菌病的念珠菌种类的转移：一项来自大学医院的7年研究和对严格意义上的假丝菌病兴起的评估。

IF 1.6 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-04-01 DOI: 10.1016/j.riam.2025.04.004

Elif Seren Tanriverdi, Yusuf Yakupogullari , Yucel Duman , Mehmet Sait Tekerekoglu , Baris Otlu

Background

Candidemia ranks the fourth most prevalent infection in healthcare settings. Notably, non-Candida albicans Candida species, particularly Candida parapsilosis, have experienced a worldwide increase as causative agents of candidemia in recent years.

Aims

This study aimed to assess shifts in prevalence and antifungal susceptibility of C. parapsilosis among candidemia-causing species over time, alongside investigating clonal relationships among isolates.

Methods

We analyzed Candida species in candidemia episodes from January 2016 to December 2022. MALDI-TOF MS identified Candida isolates at the species level, and the identification of the species within C. parapsilosis complex was achieved via the restriction fragment length polymorphism method. Fluconazole susceptibility testing followed EUCAST guidelines. Clonal relationships among C. parapsilosis isolates were assessed using three methods: AP-PCR, REA-PFGE, and electrophoretic karyotyping.

Results

Across a seven-year period, Candida prevalence among all blood cultures was 2.1% (679 cases). The most prevalent Candida species were C. parapsilosis (33.7%), C. albicans (32.7%), Nakaseomyces glabratus (formerly Candida glabrata) (14.4%), and Candida tropicalis (8%). Notably, C. parapsilosis isolation rates increased annually from 2016 to 2022. Fluconazole susceptibility of C. parapsilosis isolates declined over time, with rates decreasing from 100% in 2016 to 72.6% in 2022. Electrophoretic karyotyping exhibited superior discrimination in clonal relationship analysis (D = 0.9875).

Conclusions

Our findings highlight a concerning trend of increasing fluconazole resistance in C. parapsilosis sensu stricto over the study period. Electrophoretic karyotyping has emerged as a robust method for assessing clonal relationships. While no dominant outbreak isolate was identified, the high clustering rate suggests the potential of C. parapsilosis as a significant nosocomial infection agent in the future.

背景：念珠菌是卫生保健机构中第四大流行感染。值得注意的是，非白色念珠菌和念珠菌种类，特别是假丝酵母菌，近年来在世界范围内作为念珠菌的病原体有所增加。目的：本研究旨在评估假丝酵母菌引起的假丝酵母菌的患病率和抗真菌敏感性随时间的变化，同时调查分离株之间的克隆关系。方法：对2016年1月至2022年12月期间发生的念珠菌发作病例进行菌种分析。MALDI-TOF MS在种水平上对念珠菌分离物进行鉴定，并通过限制性片段长度多态性方法对C. parapsilosis复合体内的种进行鉴定。氟康唑药敏试验遵循EUCAST指南。采用AP-PCR、REA-PFGE和电泳核型分析三种方法，对拟裂菇分离株间的克隆关系进行了评价。结果：在7年的时间里，所有血培养中念珠菌的患病率为2.1%（679例）。最常见的念珠菌种为假丝酵母菌（33.7%）、白色念珠菌（32.7%）、光秃中丝酵母菌（14.4%）和热带假丝酵母菌（8%）。值得注意的是，从2016年到2022年，parapsilosis的分离率逐年上升。随着时间的推移，假僵菌对氟康唑的敏感性逐渐下降，从2016年的100%下降到2022年的72.6%。电泳核型在克隆亲缘分析中表现出较强的差异性（D=0.9875）。结论：我们的研究结果表明，在研究期间，严格意义上的假蝇对氟康唑的耐药性呈上升趋势。电泳核型已成为一种评估克隆关系的可靠方法。虽然没有发现显性暴发分离物，但高聚类率表明，在未来，副吸虫病有可能成为一种重要的医院感染因子。

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引用次数: 0

Real-life experience on the use of isavuconazole in solid organ transplantation 异戊康唑在实体器官移植中的应用体会。

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-01-01 DOI: 10.1016/j.riam.2025.02.004

Jose Tiago Silva , Amparo Solé , José María Aguado

Solid organ transplant (SOT) recipients have a higher risk of developing invasive fungal infection (IFI). Isavuconazole is a novel broad-spectrum azole active against Aspergillus and Mucor. Isavuconazole is well tolerated, shows an excellent bioavailability and predictable pharmacokinetics, good diffusion to tissues, significantly reduced drug–drug interactions with immunosuppressive drugs in comparison with other broad-spectrum azoles, and few serious adverse effects, including hepatic toxicity. We have performed an extensive literature review concerning the clinical experience on the use of isavuconazole in SOT as prophylaxis and treatment of IFI, which included the SOTIS and the ISASOT studies, and fourteen published case reports. Clinical response, all-cause and invasive aspergillosis-attributable mortality in recipients treated with isavuconazole were similar to those described with voriconazole. Drug–drug interactions with immunosuppressive agents were manageable after the adjustment of tacrolimus and mTOR inhibitors. Isavuconazole showed fewer drug-related side effects and a smaller rate of premature discontinuation than voriconazole. In conclusion, isavuconazole appears to be a reasonable option for the treatment of IFI in SOT, and can be an alternative to voriconazole as antifungal prophylaxis in lung transplantation. Nonetheless, more clinical studies are needed.

实体器官移植（SOT）受者发生侵袭性真菌感染（IFI）的风险较高。异唑康唑是一种具有抗曲霉和毛霉菌活性的新型广谱唑类药物。Isavuconazole耐受性良好，具有良好的生物利用度和可预测的药代动力学，良好的组织扩散，与其他广谱唑类药物相比，与免疫抑制药物的药物相互作用显著减少，并且几乎没有严重的副作用，包括肝毒性。我们对isavuconazole在SOT中预防和治疗IFI的临床经验进行了广泛的文献回顾，其中包括SOTIS和ISASOT研究，以及14份已发表的病例报告。依唑康唑治疗的患者的临床反应、全因死亡率和侵袭性曲霉菌病死亡率与伏立康唑治疗的患者相似。调整他克莫司和mTOR抑制剂后，药物与免疫抑制剂的相互作用是可控的。与伏立康唑相比，依舒康唑的药物相关副作用较少，过早停药率也较低。综上所述，isavuconazole似乎是治疗SOT中IFI的合理选择，并且可以替代voriconazole作为肺移植中的抗真菌预防药物。尽管如此，还需要更多的临床研究。

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引用次数: 0

Real-world use of isavuconazole in adult oncohematology patients isavuconazole在成人血液病患者中的实际应用。

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-01-01 DOI: 10.1016/j.riam.2025.02.001

Mi Kwon

Isavuconazole has emerged as a significant antifungal agent in the treatment and prophylaxis of invasive fungal infections (IFIs) among immunocompromised patients, particularly those undergoing hematopoietic stem cell transplantation (HSCT) or receiving treatment for hematological malignancies. Real-world experience with the use of isavuconazole in oncohematological patients has increasingly been reported. Isavuconazole has demonstrated efficacy against a broad spectrum of fungal pathogens, with a favorable safety profile and lower rates of hepatotoxicity compared to other azoles. Isavuconazole is generally well-tolerated, making it suitable for long-term use in high-risk patients for both treatment and prophylaxis of IFIs. Isavuconazole can be considered a valuable treatment option for IFIs in patients with hematological malignancies and HSCT recipients. It may be a suitable alternative to other azoles, especially in patients with underlying liver dysfunction or those experiencing the effects of multiple drug interactions. Nevertheless, further research is needed to evaluate the long-term safety and efficacy of isavuconazole, particularly in specific patient populations and in combination with other antifungal agents. Overall, isavuconazole represents a promising addition to the antifungal armamentarium, offering a safer and more effective treatment option for patients at high risk of IFIs.

Isavuconazole已成为一种重要的抗真菌药物，用于治疗和预防免疫功能低下患者的侵袭性真菌感染（IFIs），特别是那些接受造血干细胞移植（HSCT）或接受血液恶性肿瘤治疗的患者。在血液病患者中使用异戊康唑的实际经验越来越多地被报道。与其他唑类药物相比，Isavuconazole具有良好的安全性和较低的肝毒性。Isavuconazole通常耐受性良好，因此适合高风险患者长期使用，用于治疗和预防ifi。Isavuconazole可以被认为是血液恶性肿瘤和造血干细胞移植患者ifi的有价值的治疗选择。它可能是其他唑类药物的合适替代品，特别是在有潜在肝功能障碍或经历多种药物相互作用的患者中。然而，需要进一步的研究来评估isavuconazole的长期安全性和有效性，特别是在特定患者群体和与其他抗真菌药物联合使用时。总体而言，isavuconazole是抗真菌药物的一个有希望的补充，为ifi高风险患者提供了更安全、更有效的治疗选择。

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引用次数: 0

Diagnosing invasive fungal infections in the laboratory today: It's all good news? 今天在实验室诊断侵袭性真菌感染：这都是好消息吗？

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-01-01 DOI: 10.1016/j.riam.2025.01.004

Javier Pemán , Alba Ruiz-Gaitán

Despite the advances in medical science, invasive fungal infections (IFI) remain a diagnostic challenge. The increasing prevalence of IFI, driven by immunosuppressive therapies, advances in intensive care and emerging pathogens, underscores the need for early and accurate diagnosis. This review evaluates current laboratory methods for the diagnosis of IFI, highlighting their strengths and limitations.

Conventional techniques, including fungal culture, direct microscopy, and histopathology, remain the gold standard for the diagnosis of proven IFIs. These methods allow pathogen isolation, species identification and antifungal susceptibility testing. However, these techniques have limitations in terms of sensitivity and turnaround times. Although microscopy is a rapid technique, its sensitivity and species discrimination profile are limited.

Modern serological assays, such as β-d-glucan and galactomannan detection, have improved the diagnostic accuracy of probable IFI cases. Integration of these assays with clinical and radiological findings, enables earlier intervention, although this is accompanied by an increased risk of false positives and necessitates careful clinical correlation. Molecular diagnostics, particularly polymerase chain reaction (PCR), allow rapid, species-specific identification directly from clinical samples. The advent of MALDI-TOF mass spectrometry has further improved diagnostic efficiency, particularly for yeast identification, although challenges remain for filamentous fungi.

Innovative techniques, such as metagenomic sequencing, lateral-flow assays, and loop-mediated isothermal amplification, offer the potential for rapid and precise detection, even in resource-limited settings. The combination of conventional and innovative methods provides a comprehensive diagnostic framework. The continuous refinement of these tools, in conjunction with multidisciplinary collaboration, is imperative to improve the early diagnostic and targeted treatment of patients with IFI.

尽管医学进步，侵袭性真菌感染（IFI）仍然是一个诊断挑战。免疫抑制疗法、重症监护技术的进步和新出现的病原体推动了IFI患病率的上升，这凸显了早期准确诊断的必要性。这篇综述评估了目前诊断IFI的实验室方法，强调了它们的优势和局限性。传统技术，包括真菌培养、直接显微镜和组织病理学，仍然是确诊ifi的金标准。这些方法允许病原分离、物种鉴定和抗真菌药敏试验。然而，这些技术在灵敏度和周转时间方面有局限性。虽然显微镜是一种快速的技术，但它的灵敏度和物种识别谱是有限的。现代血清学检测，如β-d-葡聚糖和半乳甘露聚糖检测，提高了可能的IFI病例的诊断准确性。将这些检测与临床和放射学结果相结合，可以进行早期干预，尽管这伴随着假阳性的风险增加，需要仔细的临床相关性。分子诊断，特别是聚合酶链反应（PCR），允许直接从临床样品中快速、物种特异性鉴定。MALDI-TOF质谱法的出现进一步提高了诊断效率，特别是在酵母鉴定方面，尽管丝状真菌仍然存在挑战。创新技术，如宏基因组测序、横向流动测定和环介导等温扩增，即使在资源有限的情况下，也有可能实现快速、精确的检测。传统和创新方法的结合提供了一个全面的诊断框架。结合多学科合作，不断完善这些工具对于改善IFI患者的早期诊断和靶向治疗至关重要。

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引用次数: 0

Experience with isavuconazole in the treatment of mucormycosis and breakthrough fungal infections 异戊康唑治疗毛霉病及突破性真菌感染的体会。

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-01-01 DOI: 10.1016/j.riam.2025.01.005

Carolina Garcia-Vidal , Antonio Gallardo-Pizarro , Tommaso Francesco Aiello , Ana Martinez-Urrea , Christian Teijon-Lumbreras , Patricia Monzo-Gallo

Isavuconazole, a triazole-class antifungal, is effective and safe for both primary treatment and salvage therapy in a variety of fungal infections. This article reviews recent knowledge on the role of this antifungal in the treatment of mucormycosis and breakthrough invasive fungal infections (bIFI) during antifungal therapy. Isavuconazole has demonstrated favorable clinical outcomes and a good safety profile in various patient populations with mucormycosis, including those with comorbidities such as diabetes mellitus or severe immunosuppression. Particularly noteworthy is the fact that drug interactions in patients with mucormycosis, where a solid organ transplant was a predisposing factor, have been effectively managed. In the treatment of bIFIs, the use of isavuconazole requires a thoughtful reflection about the fungal species involved and their susceptibility profiles. This is highly dependent on the antifungal agent administered before the onset of bIFI. Early diagnosis and appropriate antifungal therapy are essential to improve outcomes in patients with mucormycosis and bIFIs. Isavuconazole represents a valuable option for managing these complex infections.

Isavuconazole是一种三唑类抗真菌药物，在各种真菌感染的初级治疗和救助治疗中都是有效和安全的。本文综述了该抗真菌药物在治疗毛霉病和突破性侵袭性真菌感染（bIFI）中的作用。Isavuconazole在各种毛霉病患者群体中显示出良好的临床结果和良好的安全性，包括患有糖尿病或严重免疫抑制等合并症的患者。特别值得注意的是，毛霉病患者的药物相互作用已得到有效控制，其中实体器官移植是一个易感因素。在治疗bIFIs时，使用异唑康唑需要对所涉及的真菌种类及其敏感性进行深思熟虑。这高度依赖于bIFI发病前使用的抗真菌药物。早期诊断和适当的抗真菌治疗对于改善毛霉病和bIFIs患者的预后至关重要。Isavuconazole是治疗这些复杂感染的一个有价值的选择。

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引用次数: 0

Pharmacological interactions of isavuconazole 异唑康唑的药理相互作用。

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-01-01 DOI: 10.1016/j.riam.2025.04.001

José Ramón Azanza Perea

The interactions between the various drugs a patient receives at any given time are crucial for justifying treatments, especially considering the often severe adverse effects associated with them. These interactions are particularly significant for azole antifungals, such as voriconazole, fluconazole, posaconazole, and itraconazole. The most recently marketed azole, isavuconazole, stands out due to its lower inhibitory effect on various CYP450 enzymes and transport proteins. While it can induce some isoenzymes of the CYP450 superfamily, its impact is minimal. As a result, we can conclude that its interactions with other drugs are less pronounced, which reduces the need for treatment adjustments or dose modifications. Additionally, isavuconazole boasts high oral bioavailability, an extensive volume of distribution, and a notably long elimination half-life. A significant side effect common to all azoles, but not associated with isavuconazole, is the prolongation of the QTc interval, which can sometimes lead to the risk of Torsades de Pointes. These advantages make isavuconazole the preferred antifungal choice for patients on multiple medications.

患者在任何给定时间接受的各种药物之间的相互作用对于证明治疗的合理性至关重要，特别是考虑到与它们相关的通常严重的副作用。这些相互作用对唑类抗真菌药物特别重要，如伏立康唑、氟康唑、泊沙康唑和伊曲康唑。最近上市的唑类药物isavuconazole因其对多种CYP450酶和转运蛋白的抑制作用较低而脱颖而出。虽然它可以诱导CYP450超家族的一些同工酶，但其影响很小。因此，我们可以得出结论，它与其他药物的相互作用不太明显，这减少了调整治疗或剂量调整的需要。此外，isavuconazole具有高的口服生物利用度、广泛的分布体积和明显长的消除半衰期。所有的唑类药物都有一个显著的副作用，但与异唑康唑无关，那就是QTc间隔的延长，这有时会导致角扭转的风险。这些优点使得isavuconazole成为使用多种药物的患者首选的抗真菌药物。

引用次数: 0

Pharmacokinetic novelties of isavuconazole. Use in special situations 异唑康唑的药代动力学新颖性。在特殊情况下使用。

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-01-01 DOI: 10.1016/j.riam.2025.02.003

Francisco Javier Candel , Mayra Matesanz , José Mensa , José Ramón Azanza

Isavuconazole, a next generation triazole, exhibits unique pharmacokinetic and pharmacodynamic properties that make it ideal for treating invasive fungal infections in critically ill and immunocompromised patients. This antifungal agent stands out for its broad spectrum of activity, which includes filamentous fungi such as Aspergillus and Mucorales, with an efficacy comparable to that of voriconazole and additional advantages against these pathogens. Its high oral bioavailability (close to 100%), prolonged half-life (>100 h), and linear, predictable pharmacokinetic profile minimize the need for frequent dose adjustments and therapeutic monitoring. Its lipophilic structure facilitates penetration into key tissues, such as the central nervous system and pulmonary tissue, as validated by clinical studies showing survival rates exceeding 70% in patients with complicated invasive fungal infection. Its use is safe in populations with renal impairment, mild to moderate hepatic impairment, paediatrics, and obesity, although dose adjustment is recommended for severe hepatic impairment. Recent studies in critically ill patients undergoing extracorporeal membrane oxygenation or continuous renal replacement therapy have revealed moderate reductions in plasma concentration, without significant clinical impact. Adaptive dosing strategies have been proposed to optimize efficacy in these cases. Compared to other triazoles, isavuconazole demonstrates a robust safety profile, with lower incidences of hepatotoxicity and neurotoxicity. Its antifungal activity, favorable pharmacokinetics, and excellent safety profile underscore its role as a reference antifungal agent, particularly in challenging clinical scenarios.

Isavuconazole是新一代三唑类药物，具有独特的药代动力学和药效学特性，是治疗危重患者和免疫功能低下患者侵袭性真菌感染的理想药物。这种抗真菌剂因其广泛的活性而脱颖而出，其中包括曲霉和毛霉菌等丝状真菌，其功效与伏立康唑相当，并且具有对抗这些病原体的额外优势。其高口服生物利用度（接近100%）、较长的半衰期（50 - 100小时）和线性、可预测的药代动力学特征，最大限度地减少了频繁剂量调整和治疗监测的需要。其亲脂性结构有助于渗透到关键组织，如中枢神经系统和肺组织，临床研究证实其在并发侵袭性真菌感染患者中的存活率超过70%。在肾功能损害、轻度至中度肝功能损害、儿科和肥胖人群中使用是安全的，但建议对严重肝功能损害进行剂量调整。最近对接受体外膜氧合或持续肾替代治疗的危重患者的研究显示，血药浓度中度降低，无显著临床影响。适应性给药策略已被提出以优化这些病例的疗效。与其他三唑类药物相比，异戊康唑具有较强的安全性，肝毒性和神经毒性发生率较低。其抗真菌活性，良好的药代动力学和良好的安全性强调了其作为抗真菌药物的参考作用，特别是在具有挑战性的临床情况下。

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引用次数: 0

Current and future use of isavuconazole in children and adolescents 异舒康唑在儿童和青少年中的现状和未来应用。

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-01-01 DOI: 10.1016/j.riam.2025.04.002

Natalia Mendoza-Palomar, Pere Soler-Palacín

Invasive fungal infections (IFI) present significant challenges in newborn, children and adolescents, particularly in immunocompromised patients, such as those with some primary immunodeficiencies or hematologic malignancies, and those who undergo hematopoietic stem cell transplantation. Isavuconazole (ISA), a broad-spectrum triazole antifungal, has emerged as an effective alternative for treating IFI in adults, especially those caused by Aspergillus and Mucorales. Recent approvals by the Food and Drug Administration (2023) and the European Medicines Agency (2024) have extended the use of ISA to paediatric populations, offering an important addition to the current treatment options. Two clinical trials have assessed ISA in paediatric patients, showing it is generally well tolerated, with an acceptable safety profile. While adverse events are primarily gastrointestinal and hepatic, they are less frequent than those associated with voriconazole or liposomal amphotericin B. According to pharmacokinetic studies, drug clearance is faster in children, particularly in those under 35 kg; thus, doses require careful modification.

ISA may represent a crucial advancement in the treatment of paediatric IFIs, but therapeutic drug monitoring remains essential due to variability in drug concentrations.

侵袭性真菌感染（IFI）对新生儿、儿童和青少年提出了重大挑战，特别是对免疫功能低下的患者，例如具有一些原发性免疫缺陷或血液恶性肿瘤的患者，以及接受造血干细胞移植的患者。Isavuconazole （ISA）是一种广谱三唑类抗真菌药物，已成为治疗成人IFI的有效替代药物，特别是由曲霉和毛霉菌引起的IFI。美国食品和药物管理局（2023年）和欧洲药品管理局（2024年）最近批准将ISA的使用扩展到儿科人群，为当前的治疗选择提供了重要的补充。两项临床试验评估了ISA在儿科患者中的应用，显示其耐受性良好，具有可接受的安全性。虽然不良事件主要发生在胃肠道和肝脏，但与伏立康唑或两性霉素b脂质体相关的不良事件相比，它们的发生率较低。根据药代动力学研究，儿童的药物清除速度更快，特别是35公斤以下的儿童；因此，剂量需要仔细调整。ISA可能是儿科ifi治疗的一个重要进展，但由于药物浓度的变化，治疗药物监测仍然是必不可少的。

{"title":"Current and future use of isavuconazole in children and adolescents","authors":"Natalia Mendoza-Palomar, Pere Soler-Palacín","doi":"10.1016/j.riam.2025.04.002","DOIUrl":"10.1016/j.riam.2025.04.002","url":null,"abstract":"<div><div>Invasive fungal infections (IFI) present significant challenges in newborn, children and adolescents, particularly in immunocompromised patients, such as those with some primary immunodeficiencies or hematologic malignancies, and those who undergo hematopoietic stem cell transplantation. Isavuconazole (ISA), a broad-spectrum triazole antifungal, has emerged as an effective alternative for treating IFI in adults, especially those caused by <em>Aspergillus</em> and Mucorales. Recent approvals by the Food and Drug Administration (2023) and the European Medicines Agency (2024) have extended the use of ISA to paediatric populations, offering an important addition to the current treatment options. Two clinical trials have assessed ISA in paediatric patients, showing it is generally well tolerated, with an acceptable safety profile. While adverse events are primarily gastrointestinal and hepatic, they are less frequent than those associated with voriconazole or liposomal amphotericin B. According to pharmacokinetic studies, drug clearance is faster in children, particularly in those under 35kg; thus, doses require careful modification.</div><div>ISA may represent a crucial advancement in the treatment of paediatric IFIs, but therapeutic drug monitoring remains essential due to variability in drug concentrations.</div></div>","PeriodicalId":21291,"journal":{"name":"Revista Iberoamericana De Micologia","volume":"42 1","pages":"Pages 32-36"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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