Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy.
J Antimicrob Chemother. 2010 Sep;65(9):2013-8. doi: 10.1093/jac/dkq240. Epub 2010 Jul 16.
In order to assess physicians' compliance with international guidelines for the targeted treatment of invasive aspergillosis, 136 patients with acute myeloid leukaemia and proven/probable invasive aspergillosis were analysed.
Compliance with Infectious Diseases Society of America (IDSA) and European Conference on Infections in Leukaemia (ECIL) guidelines was found to be relatively low (28% for ECIL and 55% for IDSA), although no significant differences were found between the two groups (adherence versus non-adherence). In both subgroup analyses (IDSA and ECIL), compliance with the guidelines did not impact the 120 day survival rate. Instead, adherence to guidelines led to a higher response rate to first-line antifungal treatment (76% in the IDSA group and 84% in the ECIL group).
Guidelines establish categories of patients with homogeneous characteristics, and suggest optimal diagnostic and therapeutic options for them. Acquisition of good results through adherence to guidelines is confirmed by our series. Unfortunately, there are frequently reasons to deviate from these general recommendations, particularly in patients with acute myeloid leukaemia. Despite evidence-based recommendations, adherence to the guidelines does not constitute the best therapeutic choice in each and every patient. Subjects' clinical conditions and co-morbidities vary widely, and sometimes render the 'recommended' drug a non-applicable strategy.
为了评估医生在侵袭性曲霉菌病靶向治疗方面遵循国际指南的情况，分析了 136 例急性髓细胞白血病且证实/疑似侵袭性曲霉菌病的患者。
发现美国传染病学会 (IDSA) 和欧洲白血病感染会议 (ECIL) 指南的依从性相对较低（ECIL 为 28%，IDSA 为 55%），尽管两组之间没有发现显著差异（依从与不依从）。在亚组分析（IDSA 和 ECIL）中，对指南的依从性并未影响 120 天生存率。相反，遵循指南可提高一线抗真菌治疗的反应率（IDSA 组为 76%，ECIL 组为 84%）。
指南确定了具有同质特征的患者类别，并为他们提出了最佳的诊断和治疗选择。我们的系列研究证实了通过遵循指南获得良好结果。不幸的是，经常有理由偏离这些一般建议，特别是在急性髓细胞白血病患者中。尽管有基于证据的建议，但在每个患者中，遵循指南并不构成最佳治疗选择。患者的临床情况和合并症差异很大，有时会使“推荐”药物成为不可行的策略。
