Sá Márcio Borges, Zaragoza Rafael
Servicio de Medicina Intensiva, Hospital Son Llàtzer, Carretera de Manacor, Palma de Mallorca, Spain.
Int J Antimicrob Agents. 2008 Nov;32 Suppl 2:S155-9. doi: 10.1016/S0924-8579(08)70018-9.
The incidence of invasive fungal infections (IFIs) has continued to grow in recent years. IFIs are associated with significant morbidity and mortality as well as costs. The diagnostic and therapeutic approaches to IFI have changed significantly in recent years, fostered by the introduction of new diagnostic methods and new antifungal products. There are also new therapeutic approaches such as de-escalation, pre-emptive antifungal treatment or combined treatment with antifungals. All of these aspects have been described in many trials, meta-analyses and reviews. There are also different clinical guidelines for IFIs with diagnostic and therapeutic recommendations. They are of unquestionable value and at the same time represent different perspectives on the problem. The lack of homogeneity when selecting and drafting the recommendations is a problem, and some of them are based more on personal opinion than on evidence. In this paper, we have put together a critical overview of the role of guidelines for IFIs, with emphasis on non-neutropenic critical patients.
近年来,侵袭性真菌感染(IFI)的发病率持续上升。IFI与显著的发病率、死亡率以及医疗费用相关。近年来,由于新诊断方法和新型抗真菌产品的引入,IFI的诊断和治疗方法发生了显著变化。还有一些新的治疗方法,如降阶梯治疗、抢先抗真菌治疗或抗真菌联合治疗。所有这些方面在许多试验、荟萃分析和综述中都有描述。对于IFI也有不同的临床指南,其中包含诊断和治疗建议。它们具有毋庸置疑的价值,同时也代表了对该问题的不同观点。在选择和制定建议时缺乏同质性是一个问题,其中一些建议更多地基于个人观点而非证据。在本文中,我们对IFI指南的作用进行了批判性综述,重点关注非中性粒细胞减少的危重症患者。