探索欧洲在重症监护病房中改善侵袭性真菌感染 (IFI) 管理的剩余治疗挑战和后续机遇方面的共识。

IF 3.6 3区 生物学 Q2 MYCOLOGY
Martin Hoenigl, David A Enoch, Dominic Wichmann, Duncan Wyncoll, Andrea Cortegiani
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引用次数: 0

摘要

背景:全球侵袭性真菌感染(IFI)的发病率正在上升,尤其是在重症监护病房(ICU)中,念珠菌属和曲霉菌属是最重要的病原体。随着抗真菌耐药性的增加和罕见真菌种类的出现,IFI 的诊断和管理变得越来越具有挑战性。本项目旨在通过一项共识调查,重点评估当前对如何管理 IFI 的看法,从而确定 ICU 中诊断和管理 IFI 所面临的挑战。该调查评估了不同国家的现状,以及参与重症监护室 IFI 护理的多学科医护人员迄今所面临的挑战:专家小组采用改良德尔菲法,就以下 6 个关键领域制定了 44 项李克特量表陈述:患者筛查和 ICU 中 IFI 诊断的最低标准;抗真菌治疗的启动和终止以及如何最大限度地减少其副作用;对该主题未来研究的见解。这些内容被用于编制在线调查问卷,并利用独立供应商(M3 Global)持有的订阅者名单以方便抽样的方式进行分发。调查对象包括英国、德国、西班牙、法国和意大利的重症监护医生、传染病专家、微生物学家和抗菌药物/重症监护病房药剂师。达成共识的阈值设定为 75%:结果:在五个月的征集期内,共收到 335 份回复。其中,29/44(66%)份陈述获得了非常高的同意率(≥ 90%),11/44(25%)份陈述获得了高同意率(结论:结果表明,医生需要更多的药剂师和药剂师之间的合作:结果表明,医生有必要了解当地 IFI 的发生率以及 ICU 中相关的唑类耐药率。在临床高度怀疑的情况下,应在收到任何诊断测试结果之前立即开始治疗。所有重症监护病房中心都应提供β-D-葡聚糖检测,并在48小时内提供结果,以便为停止经验性抗真菌治疗提供依据。这些共识声明和建议措施可为今后的进一步研究提供指导,以优化重症监护病房的 IFI 管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Exploring European Consensus About the Remaining Treatment Challenges and Subsequent Opportunities to Improve the Management of Invasive Fungal Infection (IFI) in the Intensive Care Unit.

Exploring European Consensus About the Remaining Treatment Challenges and Subsequent Opportunities to Improve the Management of Invasive Fungal Infection (IFI) in the Intensive Care Unit.

Background: The global prevalence of invasive fungal infections (IFI) is increasing, particularly within Intensive Care Units (ICU), where Candida spp. and Aspergillus spp. represent the most important pathogens. Diagnosis and management of IFIs becomes progressively challenging, with increasing antifungal resistance and the emergence of rare fungal species. Through a consensus survey focused on assessing current views on how IFI should be managed, the aim of this project was to identify challenges around diagnosing and managing IFIs in the ICU. The current status in different countries and perceived challenges to date amongst a multidisciplinary cohort of healthcare professionals involved in the care of IFI in the ICU was assessed.

Methods: Using a modified Delphi approach, an expert panel developed 44 Likert-scale statements across 6 key domains concerning patient screening and minimal standards for diagnosis of IFIs in ICU; initiation and termination of antifungal treatments and how to minimise their side effects and insights for future research on this topic. These were used to develop an online survey which was distributed on a convenience sampling basis utilising the subscriber list held by an independent provider (M3 Global). This survey was distributed to intensivists, infectious disease specialists, microbiologists and antimicrobial/ICU pharmacists within the UK, Germany, Spain, France and Italy. The threshold for consensus was set at 75%.

Results: A total of 335 responses were received during the five-month collection period. From these, 29/44 (66%) statements attained very high agreement (≥ 90%), 11/44 (25%) high agreement (< 90% and ≥ 75%), and 4/44 (9%) did not meet threshold for consensus (< 75%).

Conclusion: The results outline the need for physicians to be aware of the local incidence of IFI and the associated rate of azole resistance in their ICUs. Where high clinical suspicion exists, treatment should start immediately and prior to receiving the results from any diagnostic test. Beta-D-glucan testing should be available to all ICU centres, with results available within 48 h to inform the cessation of empirical antifungal therapy. These consensus statements and proposed measures may guide future areas for further research to optimise the management of IFIs in the ICU.

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来源期刊
Mycopathologia
Mycopathologia 生物-真菌学
CiteScore
6.80
自引率
3.60%
发文量
76
审稿时长
3 months
期刊介绍: Mycopathologia is an official journal of the International Union of Microbiological Societies (IUMS). Mycopathologia was founded in 1938 with the mission to ‘diffuse the understanding of fungal diseases in man and animals among mycologists’. Many of the milestones discoveries in the field of medical mycology have been communicated through the pages of this journal. Mycopathologia covers a diverse, interdisciplinary range of topics that is unique in breadth and depth. The journal publishes peer-reviewed, original articles highlighting important developments concerning medically important fungi and fungal diseases. The journal highlights important developments in fungal systematics and taxonomy, laboratory diagnosis of fungal infections, antifungal drugs, clinical presentation and treatment, and epidemiology of fungal diseases globally. Timely opinion articles, mini-reviews, and other communications are usually invited at the discretion of the editorial board. Unique case reports highlighting unprecedented progress in the diagnosis and treatment of fungal infections, are published in every issue of the journal. MycopathologiaIMAGE is another regular feature for a brief clinical report of potential interest to a mixed audience of physicians and laboratory scientists. MycopathologiaGENOME is designed for the rapid publication of new genomes of human and animal pathogenic fungi using a checklist-based, standardized format.
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