Lass-Flörl Cornelia, Krause Robert, Willinger Birgit, Starzengruber Peter, Decristoforo Petra, Neururer Sabrina, Kreidl Peter, Aigner Maria
Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, 8036 Graz, Austria.
J Fungi (Basel). 2020 Jun 2;6(2):76. doi: 10.3390/jof6020076.
This prospective noninterventional study evaluated whether antifungal susceptibility data (MIC) provided for clinical isolates on the basis of recently established breakpoints are taken into account by clinicians to guide their treatment decision making process, and assessed the response in MIC- and non-MIC-based treatment groups. During a six month period, the usage of systemic antifungals was recorded in detail and compared with mycological data ( species and MICs) in candidemia patients. Patients were assigned to a susceptible or resistant infection group based on European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints; treatment decisions were under the professional discretion of the treating physicians. 123 patients were evaluated with accounting for 59%, for 19%, for 15%, for 4% and for 3%. Antifungal treatment correlated with species and MICs in 80% ( = 99 patients), high MICs and species-dependent guideline recommendations were ignored in 20% ( = 24 patients); the overall outcome of candidemia cases in our study population was excellent, as by day 14, all patients were cleared from fungal blood stream infection (mean 5.6 days, range 2-12). The current variability in antifungal usage and the delay in initiating appropriate therapy indicate a need for antifungal stewardship to improve the management of invasive fungal infections.
这项前瞻性非干预性研究评估了临床医生是否会考虑根据最近确定的折点为临床分离株提供的抗真菌药敏数据（MIC），以指导其治疗决策过程，并评估了基于MIC和非MIC的治疗组的反应。在六个月的时间里，详细记录了全身性抗真菌药物的使用情况，并与念珠菌血症患者的真菌学数据（菌种和MIC）进行了比较。根据欧洲抗菌药物敏感性试验委员会（EUCAST）的折点，将患者分为易感或耐药感染组；治疗决策由治疗医生自行决定。共评估了123例患者，其中[具体情况1]占59%，[具体情况2]占19%，[具体情况3]占15%，[具体情况4]占4%，[具体情况5]占3%。80%（n = 99例患者）的抗真菌治疗与菌种和MIC相关，20%（n = 24例患者）忽略了高MIC和菌种依赖性指南建议；我们研究人群中念珠菌血症病例的总体结果良好，到第14天时，所有患者的真菌血流感染均已清除（平均5.6天，范围2 - 12天）。目前抗真菌药物使用的变异性以及开始适当治疗的延迟表明需要进行抗真菌管理，以改善侵袭性真菌感染的管理。
