■侵袭性真菌病(IFD)已成为中国乃至世界范围内严重威胁人类健康的疾病,高死亡率和高发病率。目前,IFD误诊率极高,复合处方抗真菌药的质量低,与IFD治疗相关的不良事件发生率高,导致长期住院,低临床反应,和高疾病负担,成为临床实践中的严峻挑战。抗真菌药物管理(AFS)不仅能显著提高IFD的早期诊断率,减少抗真菌药物的不当使用,改善患者预后,但也可以提高治疗安全性和降低医疗费用。因此,迫切需要确定适合中国现状的关键AFS指标。
■根据国际AFS共识建议的指标,结合中国的现状和各领域权威专家的临床经验,选择了几个指标,以及呼吸系统疾病领域的专家,血液学,重症监护病房(ICU),皮肤病学,传染病,邀请微生物学实验室和药房通过德尔菲法评估AFS指标。共识被认为是在该指标的协议水平≥80%的情况下达成的。
■达成了24个指标的共识,包括正确的患者指标(n=4),正确的时间度量(n=3),和正确使用指标(n=17)。正确使用指标进一步细分为药物选择(n=8),药物剂量(n=4),药物降(n=1),药物持续时间(n=2),和药物消耗量(n=2)指标。46位权威专家对上述指标进行了评估和评审,达成共识,22项指标的最终一致水平≥80%.
■这一共识是首次提出一套适合中国的AFS指标,这有助于在中国建立AFS标准,也是AFS在亚洲的第一个共识,并可能提高IFD的临床诊断和治疗标准,并指导医院实施AFS,最终促进抗真菌药物的合理使用,改善患者预后。
UNASSIGNED: Invasive fungal disease (IFD) has become a serious threat to human health in China and around the world, with high mortality and morbidity. Currently, the misdiagnosis rate of IFD is extremely high, compounded with the low quality of prescription antifungals and the high incidence of adverse events associated with IFD treatment, resulting in lengthy hospitalization, low clinical response, and high disease burden, which have become serious challenges in clinical practice. Antifungal stewardship (AFS) can not only significantly increase the early diagnosis rate of IFD, reduce inappropriate utilization of antifungal drugs, improve patient prognosis, but can also improve therapeutic safety and reduce healthcare expenses. Thus, it is urgent to identify key AFS metrics suitable for China\'s current situation.
UNASSIGNED: Based on metrics recommended by international AFS consensuses, combined with the current situation of China and the clinical experience of authoritative experts in various fields, several metrics were selected, and experts in the fields of respiratory diseases, hematology, intensive care units (ICUs), dermatology, infectious diseases, microbiology laboratory and pharmacy were invited to assess AFS metrics by the
Delphi method.
Consensus was considered to be reached with an agreement level of ≥80% for the metric.
UNASSIGNED: Consensus was reached for 24 metrics, including right patient metrics (n=4), right time metrics (n=3), and right use metrics (n=17). Right use metrics were further subdivided into drug choice (n=8), drug dosage (n=4), drug de-escalation (n=1), drug duration (n=2), and drug consumption (n=2) metrics. Forty-six authoritative experts assessed and reviewed the above metrics, and a
consensus was reached with a final agreement level of ≥80% for 22 metrics.
UNASSIGNED: This
consensus is the first to propose a set of AFS metrics suitable for China, which helps to establish AFS standards in China and is also the first AFS
consensus in Asia, and may improve the standard of clinical diagnosis and treatment of IFD, and guide hospitals to implement AFS, ultimately promoting the rational use of antifungal drugs and improving patient prognosis.