Wichmann Dominic, Hoenigl Martin, Koehler Philipp, Koenig Christina, Lund Frederike, Mang Sebastian, Strauß Richard, Weigand Markus A, Hohmann Christian, Kurzai Oliver, Heußel Claus, Kochanek Matthias
Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Infection. 2025 Jun 4. doi: 10.1007/s15010-025-02572-2.
The executive summary of the guideline aims to provide the most relevant recommendations on the diagnosis and treatment of invasive pulmonary aspergillosis in critically ill patients in the intensive care unit.
The guideline's work included a systematic literature search, selection and assessment of the data relevant to the issues identified. Key questions included the areas of epidemiology, risk factors, diagnostics, and therapy. They were discussed analogous to a PICO scheme within the guideline committee, with subsequent working groups proposing recommendations for specific key questions, which were then again discussed and finalized by the entire guideline committee.
In addition to the classic risk factors (persistent neutropenia, allogeneic stem cell transplantation, congenital or acquired immunodeficiency, etc.), decompensated liver cirrhosis, COPD, solid tumours and viral pneumonia (influenza, COVID-19) have been established as risk factors for critically ill patients in need of intensive care. If there is no adequate improvement or even further clinical deterioration of the respiratory status in critically ill patients, the presence of IPA should be considered and appropriate diagnostic tests should be initiated. Diagnostics should include a CT scan of the chest and a broncho-alveolar lavage with culture for moulds, testing for galactomannan and PCR. Isavuconazole and voriconazole are recommended as first-line treatment, liposomal amphotericin B as an alternative, with posaconazole (PCZ) or the echinocandins (as an add-on to azole or polyene treatment) being additional options for salvage treatment.
Invasive aspergillosis in critically ill patients represents a diagnostic and therapeutic challenge. If indicated, invasive aspergillosis should be considered and appropriate diagnostic tests initiated. Isavuconazole and voriconazole are recommended as first-line treatment, liposomal amphotericin B as an alternative.
本指南的执行摘要旨在就重症监护病房中危重症患者侵袭性肺曲霉病的诊断和治疗提供最相关的建议。
本指南的工作包括系统的文献检索、对与所确定问题相关的数据进行筛选和评估。关键问题包括流行病学、危险因素、诊断和治疗领域。在指南委员会内按照类似于PICO方案的方式对这些问题进行了讨论，随后各工作组针对具体关键问题提出建议，然后由整个指南委员会再次进行讨论并最终确定。
除了经典危险因素（持续性中性粒细胞减少、异基因造血干细胞移植、先天性或获得性免疫缺陷等）外，失代偿期肝硬化、慢性阻塞性肺疾病、实体瘤和病毒性肺炎（流感、新型冠状病毒肺炎）已被确定为需要重症监护的危重症患者的危险因素。如果危重症患者的呼吸状况没有得到充分改善甚至进一步临床恶化，应考虑侵袭性肺曲霉病的存在并启动适当的诊断检测。诊断应包括胸部CT扫描、支气管肺泡灌洗并进行霉菌培养、半乳甘露聚糖检测和聚合酶链反应。推荐艾沙康唑和伏立康唑作为一线治疗药物，脂质体两性霉素B作为替代药物，泊沙康唑（PCZ）或棘白菌素类药物（作为唑类或多烯类治疗的附加用药）作为挽救治疗的其他选择。
危重症患者的侵袭性曲霉病是一项诊断和治疗挑战。如有指征，应考虑侵袭性曲霉病并启动适当的诊断检测。推荐艾沙康唑和伏立康唑作为一线治疗药物，脂质体两性霉素B作为替代药物。
