Diagnosis and treatment of invasive pulmonary aspergillosis in critically ill intensive care patients: executive summary of the German national guideline (AWMF 113-005).

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-06-04 DOI:10.1007/s15010-025-02572-2

Dominic Wichmann, Martin Hoenigl, Philipp Koehler, Christina Koenig, Frederike Lund, Sebastian Mang, Richard Strauß, Markus A Weigand, Christian Hohmann, Oliver Kurzai, Claus Heußel, Matthias Kochanek

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引用次数: 0

Abstract

Purpose: The executive summary of the guideline aims to provide the most relevant recommendations on the diagnosis and treatment of invasive pulmonary aspergillosis in critically ill patients in the intensive care unit.

Methods: The guideline's work included a systematic literature search, selection and assessment of the data relevant to the issues identified. Key questions included the areas of epidemiology, risk factors, diagnostics, and therapy. They were discussed analogous to a PICO scheme within the guideline committee, with subsequent working groups proposing recommendations for specific key questions, which were then again discussed and finalized by the entire guideline committee.

Results: In addition to the classic risk factors (persistent neutropenia, allogeneic stem cell transplantation, congenital or acquired immunodeficiency, etc.), decompensated liver cirrhosis, COPD, solid tumours and viral pneumonia (influenza, COVID-19) have been established as risk factors for critically ill patients in need of intensive care. If there is no adequate improvement or even further clinical deterioration of the respiratory status in critically ill patients, the presence of IPA should be considered and appropriate diagnostic tests should be initiated. Diagnostics should include a CT scan of the chest and a broncho-alveolar lavage with culture for moulds, testing for galactomannan and PCR. Isavuconazole and voriconazole are recommended as first-line treatment, liposomal amphotericin B as an alternative, with posaconazole (PCZ) or the echinocandins (as an add-on to azole or polyene treatment) being additional options for salvage treatment.

Conclusion: Invasive aspergillosis in critically ill patients represents a diagnostic and therapeutic challenge. If indicated, invasive aspergillosis should be considered and appropriate diagnostic tests initiated. Isavuconazole and voriconazole are recommended as first-line treatment, liposomal amphotericin B as an alternative.

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危重重症患者侵袭性肺曲霉病的诊断和治疗：德国国家指南（AWMF 113-005）的执行摘要

目的：本指南的执行摘要旨在为重症监护室侵袭性肺曲霉病的诊断和治疗提供最相关的建议。方法：该指南的工作包括系统的文献检索，选择和评估与所确定问题相关的数据。关键问题包括流行病学、危险因素、诊断和治疗等领域。它们的讨论类似于指南委员会内部的PICO方案，随后的工作组就具体的关键问题提出建议，然后由整个指南委员会再次讨论并最终确定。结果：危重症患者需要重症监护的危险因素除了经典危险因素（持续性中性粒细胞减少、异体干细胞移植、先天性或获得性免疫缺陷等）外，失代偿性肝硬化、COPD、实体肿瘤和病毒性肺炎（流感、COVID-19）也被确定为危险因素。如果危重病人的呼吸状况没有充分改善，甚至进一步的临床恶化，应考虑IPA的存在，并应开始进行适当的诊断测试。诊断应包括胸部CT扫描、支气管肺泡灌洗霉菌培养、半乳甘露聚糖检测和PCR。Isavuconazole和voriconazole被推荐作为一线治疗，两性霉素B脂质体作为替代，泊沙康唑（PCZ）或棘白菌素（作为唑或多烯治疗的附加药物）是补救性治疗的额外选择。结论：侵袭性曲霉病对危重患者的诊断和治疗都是一个挑战。如果有指征，应考虑侵袭性曲霉病，并开始进行适当的诊断检查。依唑康唑和伏立康唑推荐作为一线治疗，两性霉素B脂质体可作为替代。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.