儿童异基因造血干细胞移植后侵袭性真菌感染流行病学及预防进展

Epidemiological characteristics of invasive fungal infection after allogeneic hematopoietic stem cell transplantation in children and advances in prevention

  • 摘要: 侵袭性真菌感染(IFI)是儿童异基因造血干细胞移植(allo-HSCT)后的严重并发症, 对患儿预后构成显著威胁。IFI的流行病学受多种因素影响而存在差异。其发生风险与多种宿主相关因素以及环境和经济条件等因素相关。主要的预防策略包括初级和二级抗真菌预防。选择抗真菌药物时需权衡疗效与安全性, 尽管传统及新型抗真菌药物提供了预防选择, 但其潜在的副作用、药物相互作用和耐药性问题亟待关注。基于风险分层的预防策略, 通过识别高风险患儿并实施针对性干预, 有助于提高预防效能, 同时避免低风险患儿不必要的药物暴露。然而, 当前预防策略仍面临药物毒性、成本效益及儿童特异性证据不足的挑战。本综述系统回顾了儿童allo-HSCT后IFI的流行病学特征、风险因素、当前的预防策略及该领域的新观点。

     

    Abstract: Invasive fungal infection (IFI) is a severe complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children, posing significant threats to patient prognosis. The epidemiology of IFI varies due to multiple influencing factors. Its occurrence risk is associated with various host-related factors as well as environmental and economic conditions. Primary and secondary antifungal prevention constitute the main prevention strategies. The selection of antifungal drugs requires a balance between efficacy and safety. Although traditional and novel antifungal drugs offer preventive options, their potential side effects, drug interactions and resistance issues demand attention. Risk-stratified prevention strategies, by identifying high-risk children and implementing targeted interventions, can enhance prevention efficacy while avoiding unnecessary drug exposure in low-risk patients. However, current prevention strategies still face challenges such as drug toxicity, cost effectiveness and insufficient child-specific evidence. This review systematically summarizes the epidemiological characteristics, risk factors, current prevention strategies and emerging perspectives in the field of IFI in patients after allo-HSCT.

     

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