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Abstract：
BACKGROUND: The global prevalence of invasive fungal infections (IFI) is increasing, particularly within Intensive Care Units (ICU), where Candida spp. and Aspergillus spp. represent the most important pathogens. Diagnosis and management of IFIs becomes progressively challenging, with increasing antifungal resistance and the emergence of rare fungal species. Through a consensus survey focused on assessing current views on how IFI should be managed, the aim of this project was to identify challenges around diagnosing and managing IFIs in the ICU. The current status in different countries and perceived challenges to date amongst a multidisciplinary cohort of healthcare professionals involved in the care of IFI in the ICU was assessed.
METHODS: Using a modified Delphi approach, an expert panel developed 44 Likert-scale statements across 6 key domains concerning patient screening and minimal standards for diagnosis of IFIs in ICU; initiation and termination of antifungal treatments and how to minimise their side effects and insights for future research on this topic. These were used to develop an online survey which was distributed on a convenience sampling basis utilising the subscriber list held by an independent provider (M3 Global). This survey was distributed to intensivists, infectious disease specialists, microbiologists and antimicrobial/ICU pharmacists within the UK, Germany, Spain, France and Italy. The threshold for consensus was set at 75%.
RESULTS: A total of 335 responses were received during the five-month collection period. From these, 29/44 (66%) statements attained very high agreement (≥ 90%), 11/44 (25%) high agreement (< 90% and ≥ 75%), and 4/44 (9%) did not meet threshold for consensus (< 75%).
CONCLUSIONS: The results outline the need for physicians to be aware of the local incidence of IFI and the associated rate of azole resistance in their ICUs. Where high clinical suspicion exists, treatment should start immediately and prior to receiving the results from any diagnostic test. Beta-D-glucan testing should be available to all ICU centres, with results available within 48 h to inform the cessation of empirical antifungal therapy. These consensus statements and proposed measures may guide future areas for further research to optimise the management of IFIs in the ICU.
METHODS: Using a modified Delphi approach, an expert panel developed 44 Likert-scale statements across 6 key domains concerning patient screening and minimal standards for diagnosis of IFIs in ICU; initiation and termination of antifungal treatments and how to minimise their side effects and insights for future research on this topic. These were used to develop an online survey which was distributed on a convenience sampling basis utilising the subscriber list held by an independent provider (M3 Global). This survey was distributed to intensivists, infectious disease specialists, microbiologists and antimicrobial/ICU pharmacists within the UK, Germany, Spain, France and Italy. The threshold for consensus was set at 75%.
RESULTS: A total of 335 responses were received during the five-month collection period. From these, 29/44 (66%) statements attained very high agreement (≥ 90%), 11/44 (25%) high agreement (< 90% and ≥ 75%), and 4/44 (9%) did not meet threshold for consensus (< 75%).
CONCLUSIONS: The results outline the need for physicians to be aware of the local incidence of IFI and the associated rate of azole resistance in their ICUs. Where high clinical suspicion exists, treatment should start immediately and prior to receiving the results from any diagnostic test. Beta-D-glucan testing should be available to all ICU centres, with results available within 48 h to inform the cessation of empirical antifungal therapy. These consensus statements and proposed measures may guide future areas for further research to optimise the management of IFIs in the ICU.
摘要：
背景：侵袭性真菌感染（FI）的全球患病率正在增加，特别是在重症监护病房(ICU)内，念珠菌属。和曲霉属。代表最重要的病原体。国际金融机构的诊断和管理变得越来越具有挑战性，随着抗真菌抗性的增加和稀有真菌物种的出现。通过一项共识调查，重点是评估当前关于应如何管理ICS的观点，该项目的目的是确定ICU中诊断和管理IFIs方面的挑战.评估了不同国家/地区的现状以及迄今为止在ICU中参与FI护理的多学科医疗专业人员队列中所面临的挑战。
方法：使用改进的Delphi方法，一个专家小组在6个关键领域制定了44份Likert量表声明,涉及患者筛查和ICU中IFIs诊断的最低标准;抗真菌治疗的开始和终止以及如何最大限度地减少其副作用和对该主题未来研究的见解.这些用于开发在线调查，该调查利用独立提供商（M3Global）持有的订户列表在方便的抽样基础上进行分发。这项调查分发给了密集人员，传染病专家,英国的微生物学家和抗菌/ICU药剂师，德国,西班牙,法国和意大利。共识的阈值设定为75%。
结果：在5个月的收集期内共收到335份回复。从这些,29/44(66%)的陈述达成了非常高的一致性(≥90%)，11/44（25%）高一致性（<90%和≥75%），4/44（9％）未达到共识阈值（<75％）。
结论：结果概述了医生需要意识到其ICU中的局部FI发生率和相关的唑类耐药率。在存在高度临床怀疑的地方，治疗应在收到任何诊断测试结果之前立即开始.β-D-葡聚糖检测应适用于所有ICU中心，结果可在48小时内告知经验性抗真菌治疗的停止。这些共识声明和建议的措施可能会指导未来领域的进一步研究，以优化ICU中的IFIs管理。
方法：使用改进的Delphi方法，一个专家小组在6个关键领域制定了44份Likert量表声明,涉及患者筛查和ICU中IFIs诊断的最低标准;抗真菌治疗的开始和终止以及如何最大限度地减少其副作用和对该主题未来研究的见解.这些用于开发在线调查，该调查利用独立提供商（M3Global）持有的订户列表在方便的抽样基础上进行分发。这项调查分发给了密集人员，传染病专家,英国的微生物学家和抗菌/ICU药剂师，德国,西班牙,法国和意大利。共识的阈值设定为75%。
结果：在5个月的收集期内共收到335份回复。从这些,29/44(66%)的陈述达成了非常高的一致性(≥90%)，11/44（25%）高一致性（<90%和≥75%），4/44（9％）未达到共识阈值（<75％）。
结论：结果概述了医生需要意识到其ICU中的局部FI发生率和相关的唑类耐药率。在存在高度临床怀疑的地方，治疗应在收到任何诊断测试结果之前立即开始.β-D-葡聚糖检测应适用于所有ICU中心，结果可在48小时内告知经验性抗真菌治疗的停止。这些共识声明和建议的措施可能会指导未来领域的进一步研究，以优化ICU中的IFIs管理。
