Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
Transpl Infect Dis. 2020 Aug;22(4):e13333. doi: 10.1111/tid.13333. Epub 2020 Jun 16.
No consensus exists regarding optimal strategy for antifungal prophylaxis following lung transplant.
To review data regarding antifungal prophylaxis on the development of fungal infections.
STUDY SELECTION/APPRAISAL: We searched MEDLINE, Embase, and Scopus for eligible articles through December 10, 2019. Observational or controlled trials published after January 1, 2001, that pertained to the prevention of fungal infections in adult lung recipients were reviewed independently by two reviewers for inclusion.
Of 1702 articles screened, 24 were included. Data were pooled using random effects model to evaluate for the primary outcome of fungal infection. Studies were stratified by prophylactic strategy, medication, and duration (short term < 6 months and long term ≥ 6 months).
We found no difference in the odds of fungal infection with universal prophylaxis (49/101) compared to no prophylaxis (36/93) (OR 0.76, CI: 0.03-17.98; I = 93%) and preemptive therapy (25/195) compared to universal prophylaxis (35/222) (OR 0.91, CI: 0.06-13.80; I = 93%). The cumulative incidence of fungal infections within 12 months was not different with nebulized amphotericin (0.08, CI: 0.04-0.13; I = 87%) compared to systemic triazoles (0.07, CI: 0.03-0.11; I = 21%) (P = .65). Likewise, duration of prophylaxis did not impact the incidence of fungal infections (short term: 0.11, CI: 0.05-0.17; I = 89%; long term: 0.06, CI: 0.03-0.08; I = 51%; P = .39).
We have insufficient evidence to support or exclude a benefit of antifungal prophylaxis.
对于肺移植后抗真菌预防的最佳策略，目前尚无共识。
综述抗真菌预防在真菌感染发展中的数据。
研究选择/评估：我们通过 MEDLINE、Embase 和 Scopus 搜索了截至 2019 年 12 月 10 日的合格文章。独立审查了两名评审员纳入的成人肺接受者中预防真菌感染的观察性或对照试验。
在筛选出的 1702 篇文章中，有 24 篇被纳入。使用随机效应模型汇总数据，以评估主要结局真菌感染。研究按预防策略、药物和持续时间（<6 个月为短期和≥6 个月为长期）进行分层。
我们发现，与无预防相比，普遍预防（49/101）与无预防（36/93）（OR 0.76，CI：0.03-17.98；I = 93%）和抢先治疗（25/195）与普遍预防（35/222）（OR 0.91，CI：0.06-13.80；I = 93%）相比，真菌感染的可能性没有差异。12 个月内真菌感染的累积发生率在使用雾化两性霉素（0.08，CI：0.04-0.13；I = 87%）与系统三唑类药物（0.07，CI：0.03-0.11；I = 21%）之间无差异（P = 0.65）。同样，预防持续时间也不会影响真菌感染的发生率（短期：0.11，CI：0.05-0.17；I = 89%；长期：0.06，CI：0.03-0.08；I = 51%；P = 0.39）。
我们没有足够的证据支持或排除抗真菌预防的益处。
