PDF(Sci-hub)
Abstract：
BACKGROUND: Although the management of invasive fungal infection (IFI) has improved, a number of controversies persist regarding the approach to invasive fungal infection in non-neutropenic medical ward patients.
OBJECTIVE: To identify the essential clinical knowledge to elaborate a set of recommendations with a high level of consensus necessary for the management of IFI in non-neutropenic medical ward patients.
METHODS: A prospective, Spanish questionnaire, which measures consensus through the Delphi technique, was anonymously answered and e-mailed by 30 multidisciplinary national experts, all specialists (intensivists, anesthesiologists, microbiologists, pharmacologists and specialists in infectious diseases) in IFI and belonging to six scientific national societies. They responded to five questions prepared by the coordination group after a thorough review of the literature published in the last few years. For a category to be selected, the level of agreement among the experts in each category had to be equal to or greater than 70%. In a second round, 73 specialists attended a face-to-face meeting held after extracting the recommendations from the chosen topics, and validated the pre-selected recommendations and derived algorithm.
RESULTS: The following recommendations were validated and included in the algorithm: 1. several elements were identified as risk factors for invasive candidiasis (IC) in non-hematologic medical patients; 2. no agreement on the use of the colonization index to decide whether prescribing an early antifungal treatment to stable patients (no shock), with sepsis and no other evident focus and IC risk factors; 3. agreement on the use of the Candida Score to decide whether prescribing early antifungal treatment to stable patients (no shock) with sepsis and no other evident focus and IC risk factors; 4. agreement on initiating early antifungal treatment in stable patients (no shock) with a colonization index>0.4, sepsis with no other evident focus and IC risk factors; 5. agreement on the performance of additional procedures in stable patients (no shock) with sepsis and no other evident focus, IC risk factors, without colonization index>0.4, but with a high degree of suspicion.
CONCLUSIONS: Based on the expert\'s recommendations, an algorithm for the management of non-neutropenic medical patients was constructed and validated. This algorithm may be useful to support bedside prescription.
OBJECTIVE: To identify the essential clinical knowledge to elaborate a set of recommendations with a high level of consensus necessary for the management of IFI in non-neutropenic medical ward patients.
METHODS: A prospective, Spanish questionnaire, which measures consensus through the Delphi technique, was anonymously answered and e-mailed by 30 multidisciplinary national experts, all specialists (intensivists, anesthesiologists, microbiologists, pharmacologists and specialists in infectious diseases) in IFI and belonging to six scientific national societies. They responded to five questions prepared by the coordination group after a thorough review of the literature published in the last few years. For a category to be selected, the level of agreement among the experts in each category had to be equal to or greater than 70%. In a second round, 73 specialists attended a face-to-face meeting held after extracting the recommendations from the chosen topics, and validated the pre-selected recommendations and derived algorithm.
RESULTS: The following recommendations were validated and included in the algorithm: 1. several elements were identified as risk factors for invasive candidiasis (IC) in non-hematologic medical patients; 2. no agreement on the use of the colonization index to decide whether prescribing an early antifungal treatment to stable patients (no shock), with sepsis and no other evident focus and IC risk factors; 3. agreement on the use of the Candida Score to decide whether prescribing early antifungal treatment to stable patients (no shock) with sepsis and no other evident focus and IC risk factors; 4. agreement on initiating early antifungal treatment in stable patients (no shock) with a colonization index>0.4, sepsis with no other evident focus and IC risk factors; 5. agreement on the performance of additional procedures in stable patients (no shock) with sepsis and no other evident focus, IC risk factors, without colonization index>0.4, but with a high degree of suspicion.
CONCLUSIONS: Based on the expert\'s recommendations, an algorithm for the management of non-neutropenic medical patients was constructed and validated. This algorithm may be useful to support bedside prescription.
摘要：
背景：尽管侵袭性真菌感染（FI）的管理有所改善，关于非中性粒细胞减少的内科病房患者的侵袭性真菌感染的方法，仍然存在许多争议。
目的：确定必要的临床知识，为非中性粒细胞减少的内科病房患者制定一套具有高度共识的建议。
方法：前瞻性，西班牙问卷，通过德尔菲技术衡量共识，由30名多学科国家专家匿名回答并通过电子邮件发送，所有专家(强化专家，麻醉师,微生物学家,感染性疾病的药理学家和专家），并属于六个科学国家学会。在对过去几年发表的文献进行全面审查后，他们回答了协调小组提出的五个问题。对于要选择的类别，每个类别的专家之间的一致水平必须等于或大于70%。在第二轮中，73名专家参加了从所选主题中提取建议后举行的面对面会议，并验证了预选的建议和推导的算法。
结果：验证了以下建议并将其包含在算法中：1.在非血液内科患者中,有几个因素被确定为侵袭性念珠菌病(IC)的危险因素;2.对于使用定植指数来决定是否对稳定患者（无休克）进行早期抗真菌治疗，伴脓毒症且无其他明显病灶及IC危险因素；3.同意使用念珠菌评分来决定是否对脓毒症且无其他明显病灶和IC危险因素的稳定患者(无休克)进行早期抗真菌治疗;4.对于定植指数>0.4、无其他明显病灶的脓毒症和IC危险因素的稳定患者(无休克)开始早期抗真菌治疗的协议;5.同意在稳定的脓毒症患者（无休克）中执行其他程序，没有其他明显的重点，IC风险因素，无定殖指数>0.4,但具有高度怀疑。
结论：根据专家的建议，我们构建并验证了治疗非中性粒细胞减少患者的算法.该算法可以或许有用的支撑床边处方。
目的：确定必要的临床知识，为非中性粒细胞减少的内科病房患者制定一套具有高度共识的建议。
方法：前瞻性，西班牙问卷，通过德尔菲技术衡量共识，由30名多学科国家专家匿名回答并通过电子邮件发送，所有专家(强化专家，麻醉师,微生物学家,感染性疾病的药理学家和专家），并属于六个科学国家学会。在对过去几年发表的文献进行全面审查后，他们回答了协调小组提出的五个问题。对于要选择的类别，每个类别的专家之间的一致水平必须等于或大于70%。在第二轮中，73名专家参加了从所选主题中提取建议后举行的面对面会议，并验证了预选的建议和推导的算法。
结果：验证了以下建议并将其包含在算法中：1.在非血液内科患者中,有几个因素被确定为侵袭性念珠菌病(IC)的危险因素;2.对于使用定植指数来决定是否对稳定患者（无休克）进行早期抗真菌治疗，伴脓毒症且无其他明显病灶及IC危险因素；3.同意使用念珠菌评分来决定是否对脓毒症且无其他明显病灶和IC危险因素的稳定患者(无休克)进行早期抗真菌治疗;4.对于定植指数>0.4、无其他明显病灶的脓毒症和IC危险因素的稳定患者(无休克)开始早期抗真菌治疗的协议;5.同意在稳定的脓毒症患者（无休克）中执行其他程序，没有其他明显的重点，IC风险因素，无定殖指数>0.4,但具有高度怀疑。
结论：根据专家的建议，我们构建并验证了治疗非中性粒细胞减少患者的算法.该算法可以或许有用的支撑床边处方。
