Invasive fungal diseases (IFDs) are a relevant cause of morbidity and mortality in children with cancer. Their correct prevention and management impact patients’ outcomes. The aim of this review is to highlight the rationale and novel insights into antifungal prophylaxis and treatment in pediatric patients with oncological and hematological diseases. The literature analysis showed that IFDs represent a minority of cases in comparison to bacterial and viral infections, but their impact might be far more serious, especially when prolonged antifungal therapy or invasive surgical treatments are required to eradicate colonization. A personalized approach is recommended since pediatric patients with cancer often present with different complications and require tailored therapy. Moreover, while the Aspergillus infection rate does not seem to increase, in the near future, new therapeutic recommendations should be required in light of new epidemiological data on Candidemia due to resistant species. Finally, further studies on CAR-T treatment and other immunotherapies are needed in patients with unique needs and the risk of complications. Definitive guidelines on IFD treatment considering the evolving epidemiology of antifungal resistance, new therapeutic approaches in pediatric cancer, novel antifungal drugs and the importance of an appropriate antifungal stewardship are urgently needed.

中文翻译：

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对儿童癌症患者真菌感染预防和治疗的新见解

侵袭性真菌病 (IFD) 是癌症儿童发病率和死亡率的相关原因。他们正确的预防和管理会影响患者的预后。本综述的目的是强调对患有肿瘤和血液疾病的儿科患者进行抗真菌预防和治疗的基本原理和新见解。文献分析表明，与细菌和病毒感染相比，IFDs 仅代表少数病例，但它们的影响可能要严重得多，尤其是当需要长期抗真菌治疗或侵入性手术治疗来根除定植时。建议采用个性化方法，因为患有癌症的儿科患者通常会出现不同的并发症并需要量身定制的治疗。此外，虽然曲霉感染率似乎没有增加，在不久的将来，应根据耐药菌引起的念珠菌病的新流行病学数据提出新的治疗建议。最后，需要对有独特需求和并发症风险的患者进行 CAR-T 治疗和其他免疫疗法的进一步研究。考虑到不断发展的抗真菌耐药性流行病学、儿科癌症的新治疗方法、新型抗真菌药物以及适当的抗真菌管理的重要性，迫切需要关于 IFD 治疗的权威指南。