实体器官移植抗真菌预防的最新趋势：来自ESCMID-EFISG、ESCMID-ESGICH、SITA和SEIMC-GESITRA-IC的研究

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-07-04 DOI:10.1007/s15010-025-02575-z

Jon Salmanton-García, Alessandro Giacinta, Maddalena Giannella, Antonio Vena, Patricia Muñoz, Oliver A Cornely, Maricela Valerio

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引用次数: 0

摘要

侵袭性真菌疾病（IFD）对实体器官移植受者存在严重风险，特别是在移植后的头180天。现有的欧洲和美国指南提供的证据有限，由于不良反应、药物相互作用和成本，促使人们转向普遍预防。本研究调查了移植中心的抗真菌预防实践，以指导IFD的管理。方法：于2023年5月至2024年5月，在三级医疗机构完成移植后抗真菌预防的在线调查。数据包括移植量、病原体引起的IFD发病率和预防策略。结果：来自32个国家（主要在欧洲）64个中心的回复强调肾脏和肝脏是最常见的移植。预防在肺移植中普遍存在，在肝、肠和心脏移植中也很常见，通常由再次干预或念珠菌定植引起。首选药物包括两性霉素B脂质体和氟康唑。结论：这项全球调查揭示了实体器官移植中心抗真菌预防实践的实质性差异，这是由于缺乏标准化、循证指南的驱动。我们的发现强调了迫切需要统一的建议，以反映不断发展的真菌流行病学，改进的诊断和新的抗真菌药物。

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Current trends on antifungal prophylaxis in solid organ transplantation: a study from ESCMID-EFISG, ESCMID-ESGICH, SITA, and SEIMC-GESITRA-IC.

Introduction: Invasive fungal diseases (IFD) present serious risks to solid organ transplant recipients, particularly in the first 180 days post-transplant. Existing European and US guidelines offer limited evidence, prompting a shift away from universal prophylaxis due to adverse effects, drug-interactions, and costs. This study investigates antifungal prophylaxis practices in transplant centers to guide IFD management.

Methods: From May 2023 to May 2024, tertiary care institutions completed an online survey on antifungal prophylaxis post-transplant. Data included transplant volumes, IFD incidence by pathogen, and prophylactic strategies.

Results: Responses from 64 centers in 32 countries, mainly in Europe, highlighted kidney and liver as the most common transplants. Prophylaxis was universal in lung transplants and common in liver, bowel, and heart transplants, often triggered by reintervention or Candida spp. colonization. Preferred agents included liposomal amphotericin B and fluconazole.

Conclusions: This global survey reveals substantial variation in antifungal prophylaxis practices among solid organ transplant centers, driven by a lack of standardized, evidence-based guidelines. Our findings underscore the urgent need for harmonized recommendations that reflect evolving fungal epidemiology, improved diagnostics, and new antifungal agents.

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.