Pemán Javier, Aguilar Gerardo, Valía Juan Carlos, Salavert Miguel, Navarro David, Zaragoza Rafael
Servicio de Microbiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Servicio de Microbiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Rev Iberoam Micol. 2017 Jul-Sep;34(3):130-142. doi: 10.1016/j.riam.2016.12.001. Epub 2017 May 31.
Although the management of the invasive candidiasis has improved in the last decade, controversial issues yet remain, especially in the diagnostic and therapeutic approaches to Candida peritonitis and other forms of intra-abdominal fungal infections.
We sought to identify core clinical knowledge about intra-abdominal fungal infections and to achieve high-agreement recommendations required to care for critically ill adult patients with Candida peritonitis and other forms of intra-abdominal fungal infection.
A biregional Spanish survey, to elucidate the consensus about the already mentioned fungal infections by means of the Delphi technique, was conducted anonymously by e-mail with 29 multidisciplinary experts in invasive fungal infections from 14 hospitals in the Valencia and Murcia communities during 2014. Respondents included intensivists, anesthesiologists, microbiologists, pharmacologists, and infectious disease specialists, who answered 31 questions prepared by a coordination group after a strict review of the literature from the 5 previous years. The educational objectives spanned 6 categories: epidemiology, microbiological diagnosis, clinical diagnosis, antifungal treatment, de-escalation therapy, and special situations. The agreement required among the panelists for each item to be selected had to be higher than 70%. After extracting the recommendations from the selected items, a meeting at which the experts were asked to validate the previously selected recommendations in a second round of scoring took place.
After the second round, 36 recommendations were validated according to the following distribution: epidemiology (5), microbiological diagnosis (4), clinical diagnosis (4), antifungal treatment (3), de-escalation therapy (4), and special situations (16).
Treatment of Candida peritonitis and other forms of intra-abdominal fungal infections in ICU patients requires a broad range of knowledge application and skills that our recommendations address. Based on the DELPHI methodology, these recommendations might help to optimize the therapeutic management of these patients in special situations and in various scenarios to improve their outcome.
尽管在过去十年中侵袭性念珠菌病的管理有所改善，但仍存在争议性问题，尤其是在念珠菌性腹膜炎和其他形式的腹腔内真菌感染的诊断和治疗方法方面。
我们试图确定关于腹腔内真菌感染的核心临床知识，并达成对患有念珠菌性腹膜炎和其他形式腹腔内真菌感染的重症成年患者进行护理所需的高度一致的建议。
2014年，通过电子邮件对来自巴伦西亚和穆尔西亚地区14家医院的29名侵袭性真菌感染多学科专家进行了一项双区域西班牙调查，以通过德尔菲技术阐明对上述真菌感染的共识。受访者包括重症监护医生、麻醉师、微生物学家、药理学家和传染病专家，他们回答了协调小组在对前五年的文献进行严格审查后准备的31个问题。教育目标涵盖6个类别：流行病学、微生物学诊断、临床诊断、抗真菌治疗、降阶梯治疗和特殊情况。专家小组对每个要选择的项目达成的一致意见必须高于70%。从选定的项目中提取建议后，召开了一次会议，要求专家们在第二轮评分中对先前选定的建议进行验证。
在第二轮之后，36项建议得到了验证，分布如下：流行病学（5项）、微生物学诊断（4项）、临床诊断（4项）、抗真菌治疗（3项）、降阶梯治疗（4项）和特殊情况（16项）。
ICU患者念珠菌性腹膜炎和其他形式腹腔内真菌感染的治疗需要广泛的知识应用和技能，我们的建议涉及这些方面。基于德尔菲方法，这些建议可能有助于在特殊情况和各种场景中优化这些患者的治疗管理，以改善其预后。
