Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Paris, France.
Institut Pasteur, CNRS, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, UMR2000, Paris, France.
Mycoses. 2020 May;63(5):420-429. doi: 10.1111/myc.13056. Epub 2020 Mar 4.
Invasive pulmonary aspergillosis (IPA) optimal duration of antifungal treatment is not known. In a joint effort, four international scientific societies/groups performed a survey to capture current practices in European haematology centres regarding management of IPA. We conducted a cross-sectional internet-based questionnaire survey in 2017 to assess practices in sixteen European countries concerning IPA management in haematology patients including tools to evaluate treatment response, duration and discontinuation. The following four groups/societies were involved in the project: European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Fungal Infection Study Group (EFISG), Infectious Diseases Working Party-European Society for Blood and Bone Marrow Transplantation (IDWP-EBMT), European Organisation for Research and Treatment-Infectious Disease group (EORTC-IDG) and Sorveglianza Epidemiologica Infezioni nelle Emopatie (SEIFEM). A total of 112 physicians from 14/16 countries answered the survey. Galactomannan antigen was available in serum and bronchoalveolar lavage in most centres (106/112 [95%] and 97/112 [87%], respectively), quantitative Aspergillus PCR in 27/112 (24%) centres, β-D-glucan in 24/112 (21%) and positron emission tomography in 50/112 (45%). Treatment duration differed between haematological malignancies, with a median duration of 6 weeks [IQR 3-12] for patients with AML, 11 [4-12] for patients with allogenic stem cell transplantation and GvHD and 6 [3-12] for patients with lymphoproliferative disease. Treatment duration significantly differed according to country. Essential IPA biomarkers are not available in all European countries, and treatment duration is highly variable according to country. It will be important to provide guidelines to help with IPA treatment cessation with algorithms according to biomarker availability.
侵袭性肺曲霉病（IPA）的最佳抗真菌治疗时间尚不清楚。四个国际科学学会/团体联合开展了一项调查，以了解欧洲血液学中心在 IPA 管理方面的当前实践。我们于 2017 年进行了一项基于互联网的横断面调查，以评估欧洲 16 个国家/地区在血液学患者 IPA 管理方面的实践，包括评估治疗反应、持续时间和停药的工具。参与该项目的四个团体/学会包括：欧洲临床微生物学和传染病学会（ESCMID）真菌感染研究组（EFISG）、传染病工作组-欧洲血液和骨髓移植学会（IDWP-EBMT）、欧洲癌症研究与治疗组织-传染病组（EORTC-IDG）和 Sorveglianza Epidemiologica Infezioni nelle Emopatie（SEIFEM）。来自 14/16 个国家的 112 名医生回答了调查。大多数中心都可提供血清和支气管肺泡灌洗液中的半乳甘露聚糖抗原（106/112 [95%]和 97/112 [87%]），27/112（24%）中心可提供定量曲霉 PCR，24/112（21%）中心可提供 β-D-葡聚糖，50/112（45%）中心可提供正电子发射断层扫描。血液病患者的治疗持续时间不同，AML 患者的中位治疗时间为 6 周[IQR 3-12]，同种异体干细胞移植和移植物抗宿主病患者为 11 周[4-12]，淋巴增殖性疾病患者为 6 周[3-12]。治疗持续时间因国家而异。并非所有欧洲国家都有 IPA 的基本生物标志物，而且治疗持续时间因国家而异。重要的是要提供指南，帮助根据生物标志物的可用性制定 IPA 治疗停药的算法。
