Peral Jose, Estella Ángel, Nuvials Xavier, Rodríguez Alejandro, Seijas Iratxe, Soriano Cruz, Suberviola Borja, Zaragoza Rafael
Intensive Care Unit, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain.
Intensive Care Unit, Medicine Department, University of Cádiz, University Hospital of Jerez, INIBiCA, 11407 Jerez, Spain.
J Fungi (Basel). 2023 Mar 2;9(3):312. doi: 10.3390/jof9030312.
The aim of this study was to establish practical recommendations for the diagnosis and treatment of influenza-associated invasive aspergillosis (IAPA) based on the available evidence and experience acquired in the management of patients with COVID-19-associated pulmonary aspergillosis (CAPA). The CAPA/IAPA expert group defined 14 areas in which recommendations would be made. To search for evidence, the PICO strategy was used for both CAPA and IAPA in PubMed, using MeSH terms in combination with free text. Based on the results, each expert developed recommendations for two to three areas that they presented to the rest of the group in various meetings in order to reach consensus. As results, the practical recommendations for the management of CAPA/IAPA patients have been grouped into 12 sections. These recommendations are presented for both entities in the following situations: when to suspect fungal infection; what diagnostic methods are useful to diagnose these two entities; what treatment is recommended; what to do in case of resistance; drug interactions or determination of antifungal levels; how to monitor treatment effectiveness; what action to take in the event of treatment failure; the implications of concomitant corticosteroid administration; indications for the combined use of antifungals; when to withdraw treatment; what to do in case of positive cultures for spp. in a patient with severe viral pneumonia or Aspergillus colonization; and how to position antifungal prophylaxis in these patients. Available evidence to support the practical management of CAPA/IAPA patients is very scarce. Accumulated experience acquired in the management of CAPA patients can be very useful for the management of IAPA patients. The expert group presents eminently practical recommendations for the management of CAPA/IAPA patients.
本研究的目的是基于在新冠病毒相关肺曲霉病（CAPA）患者管理中获得的现有证据和经验，为流感相关侵袭性曲霉病（IAPA）的诊断和治疗制定切实可行的建议。CAPA/IAPA专家组确定了14个将提出建议的领域。为了检索证据，在PubMed中对CAPA和IAPA均使用PICO策略，结合医学主题词（MeSH）和自由文本进行检索。基于检索结果，每位专家针对两到三个领域制定建议，并在多次会议上向小组其他成员提出，以达成共识。结果，CAPA/IAPA患者管理的实用建议被归纳为12个部分。这些建议针对这两种情况在以下情形中给出：何时怀疑真菌感染；哪些诊断方法对诊断这两种情况有用；推荐何种治疗；出现耐药时该怎么做；药物相互作用或抗真菌药水平的测定；如何监测治疗效果；治疗失败时采取什么行动；同时使用皮质类固醇的影响；联合使用抗真菌药的指征；何时停止治疗；重症病毒性肺炎患者或曲霉菌定植患者培养出 属阳性时该怎么做；以及如何对这些患者进行抗真菌预防。支持CAPA/IAPA患者实际管理的现有证据非常匮乏。在CAPA患者管理中积累的经验对IAPA患者的管理可能非常有用。专家组为CAPA/IAPA患者的管理提出了极具实用性的建议。
