Abstract：
BACKGROUND: Invasive fungal infections (IFI) are a relevant cause of morbidity and mortality among patients with haematological neoplasms (HMs). Since 2002, a classification of IFI based on host factors, clinical and radiological features and mycological tests was published for research purpose.
OBJECTIVE: These criteria are widely used in clinical practice to identify patients at risk for IFI. The aim of the study was to evaluate the clinical applicability of EORTC/MSG 2008 criteria for the diagnosis of IFI in daily practice.
METHODS: This multicentre, non-interventional, observational, prospective study gathered all consecutive inpatients with HMs in which an intravenous antifungal treatment was started. Exclusion criteria were a previous or concomitant transplant procedure, outpatient status and oral antifungal therapy. EORTC/MSG 2008 criteria were used to classify patients at the beginning of antifungal therapy and at 30 days. An independent board reviewed the classification of IFI given by local clinicians at T0 and T30.
RESULTS: The highest percentage of agreement was found for possible IFI (96%), while a lower agreement was reported for proven IFI (74%), and the highest variability was observed for probable IFI (56%). At T30, the board re-evaluation confirmed a strict agreement for possible IFI only (98%). Among 306 patients classified as possible, 156 (51%) patients showed non-typical radiological findings and 45 (15%) patients presented host factors only.
CONCLUSIONS: In real life, the EORTC/MSG criteria can be applicable only for possible IFI. As non-typical radiological findings are reported in possible IFI, introducing a new IFI category should be considered.
OBJECTIVE: These criteria are widely used in clinical practice to identify patients at risk for IFI. The aim of the study was to evaluate the clinical applicability of EORTC/MSG 2008 criteria for the diagnosis of IFI in daily practice.
METHODS: This multicentre, non-interventional, observational, prospective study gathered all consecutive inpatients with HMs in which an intravenous antifungal treatment was started. Exclusion criteria were a previous or concomitant transplant procedure, outpatient status and oral antifungal therapy. EORTC/MSG 2008 criteria were used to classify patients at the beginning of antifungal therapy and at 30 days. An independent board reviewed the classification of IFI given by local clinicians at T0 and T30.
RESULTS: The highest percentage of agreement was found for possible IFI (96%), while a lower agreement was reported for proven IFI (74%), and the highest variability was observed for probable IFI (56%). At T30, the board re-evaluation confirmed a strict agreement for possible IFI only (98%). Among 306 patients classified as possible, 156 (51%) patients showed non-typical radiological findings and 45 (15%) patients presented host factors only.
CONCLUSIONS: In real life, the EORTC/MSG criteria can be applicable only for possible IFI. As non-typical radiological findings are reported in possible IFI, introducing a new IFI category should be considered.
摘要：
背景：侵袭性真菌感染（FI）是血液肿瘤（HM）患者发病和死亡的相关原因。自2002年以来，根据宿主因素对FI进行了分类，临床和放射学特征和真菌学测试发表用于研究目的.
目的：这些标准在临床实践中广泛用于识别有风险的患者。该研究的目的是评估EORTC/MSG2008标准在日常实践中诊断的临床适用性。
方法：这个多中心，非干预性，观察,前瞻性研究收集了所有开始静脉抗真菌治疗的HMs连续住院患者.排除标准是先前或伴随的移植程序，门诊情况和口服抗真菌治疗。使用EORTC/MSG2008标准对开始抗真菌治疗和30天的患者进行分类。一个独立的委员会审查了当地临床医生在T0和T30给出的FI分类。
结果：对于可能的FI，发现最高百分比的协议（96％），虽然据报道，经过验证的国际金融机构的协议较低(74%)，并且观察到的变异性最高的是可能的FI（56％）。在T30，董事会重新评估确认了仅对可能的FI（98％）的严格协议。在被分类为可能的306名患者中，156例（51％）患者表现出非典型的放射学发现，45例（15％）患者仅表现出宿主因素。
结论：在现实生活中，EORTC/MSG标准仅适用于可能的FI。由于非典型的放射学结果在可能的FI中报告，应该考虑引入一个新的FI类别。
目的：这些标准在临床实践中广泛用于识别有风险的患者。该研究的目的是评估EORTC/MSG2008标准在日常实践中诊断的临床适用性。
方法：这个多中心，非干预性，观察,前瞻性研究收集了所有开始静脉抗真菌治疗的HMs连续住院患者.排除标准是先前或伴随的移植程序，门诊情况和口服抗真菌治疗。使用EORTC/MSG2008标准对开始抗真菌治疗和30天的患者进行分类。一个独立的委员会审查了当地临床医生在T0和T30给出的FI分类。
结果：对于可能的FI，发现最高百分比的协议（96％），虽然据报道，经过验证的国际金融机构的协议较低(74%)，并且观察到的变异性最高的是可能的FI（56％）。在T30，董事会重新评估确认了仅对可能的FI（98％）的严格协议。在被分类为可能的306名患者中，156例（51％）患者表现出非典型的放射学发现，45例（15％）患者仅表现出宿主因素。
结论：在现实生活中，EORTC/MSG标准仅适用于可能的FI。由于非典型的放射学结果在可能的FI中报告，应该考虑引入一个新的FI类别。
