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经验性抗真菌治疗的生存结果及早期开始治疗的价值：过去十年综述

Survival Outcome of Empirical Antifungal Therapy and the Value of Early Initiation: A Review of the Last Decade.

作者信息

Kanj Souha S, Omrani Ali S, Al-Abdely Hail M, Subhi Ahmad, Fakih Riad El, Abosoudah Ibraheem, Kanj Hazar, Dimopoulos George

机构信息

Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut P.O. Box 11-0236, Lebanon.

Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar.

出版信息

J Fungi (Basel). 2022 Oct 29;8(11):1146. doi: 10.3390/jof8111146.

DOI:10.3390/jof8111146
PMID:36354913
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9695378/
Abstract

AIM

This rapid systematic review aimed to collect the evidence published over the last decade on the effect of empirical antifungal therapy and its early initiation on survival rates.

METHODS

A systematic search was conducted in PubMed, Cochrane, Medline, Scopus, and Embase, in addition to a hand search and experts' suggestions.

RESULTS

Fourteen cohort studies and two randomized clinical trials reporting the survival outcome of empirical antifungal therapy were included in this review. Two studies reported the association between early empirical antifungal therapy (EAFT) and survival rates in a hematological cancer setting, and fourteen studies reported the outcome in patients in intensive care units (ICU). Six studies reported that appropriate EAFT decreases hospital mortality significantly; ten studies could not demonstrate a statistically significant association with mortality rates.

DISCUSSION

The inconsistency of the results in the literature can be attributed to the studies' small sample size and their heterogeneity. Many patients who may potentially benefit from such strategies were excluded from these studies.

CONCLUSION

While EAFT is practiced in many settings, current evidence is conflicting, and high-quality studies are needed to demonstrate the true value of this approach. Meanwhile, insights from experts in the field can help guide clinicians to initiate EAFT when indicated.

摘要

目的

本快速系统评价旨在收集过去十年发表的关于经验性抗真菌治疗及其早期启动对生存率影响的证据。

方法

除手工检索和专家建议外，还在PubMed、Cochrane、Medline、Scopus和Embase中进行了系统检索。

结果

本评价纳入了14项队列研究和2项报告经验性抗真菌治疗生存结局的随机临床试验。两项研究报告了血液系统癌症患者中早期经验性抗真菌治疗（EAFT）与生存率之间的关联，14项研究报告了重症监护病房（ICU）患者的结局。6项研究报告称，适当的EAFT可显著降低医院死亡率；10项研究未能证明与死亡率存在统计学上的显著关联。

讨论

文献结果的不一致可归因于研究样本量小及其异质性。许多可能从这些策略中获益的患者被排除在这些研究之外。

结论

虽然EAFT在许多情况下都有应用，但目前的证据相互矛盾，需要高质量的研究来证明这种方法的真正价值。同时，该领域专家的见解有助于指导临床医生在有指征时启动EAFT。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/afb324208dda/jof-08-01146-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/34c3d10ecf1d/jof-08-01146-g0A1.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/2867f360e229/jof-08-01146-g0A4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/009f460f390a/jof-08-01146-g0A5.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/9ed7f7325ee8/jof-08-01146-g0A7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/4b08f1551d0c/jof-08-01146-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/afb324208dda/jof-08-01146-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/34c3d10ecf1d/jof-08-01146-g0A1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/9ae10f71f57e/jof-08-01146-g0A2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/568ee46fe210/jof-08-01146-g0A3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/2867f360e229/jof-08-01146-g0A4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/009f460f390a/jof-08-01146-g0A5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/2d364f6384a9/jof-08-01146-g0A6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/9ed7f7325ee8/jof-08-01146-g0A7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/4b08f1551d0c/jof-08-01146-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a90f/9695378/afb324208dda/jof-08-01146-g002.jpg

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