Intensive care medicine research agenda on invasive fungal infection in critically ill patients
Intensive care medicine research agenda on invasive fungal infection in critically ill patients
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DOI：
10.1007/s00134-017-4731-2
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发表时间：
2017-09-01
影响因子：
38.9
通讯作者：
Cornely, Oliver A.
中科院分区：
文献类型：
--
作者：
Bassetti, Matteo;Garnacho-Montero, Jose;Cornely, Oliver A.
目的：简要描述当前的护理标准、最近的主要进展、与最近的试验相矛盾的共同信念、不确定性领域以及未来十年需要进行的临床研究及其在ICU环境中非血小板减少患者中念珠菌和曲霉感染的预期结果。方法：考虑到国家和国际的指导方针和专家opinion.Results：严重的侵袭性真菌感染（IFIs）的医学文献的系统性综述在危重患者越来越频繁。大约80%的IFIs是由于念珠菌属。曲霉菌0.3 ~ 19%。最近的观察强调了建立一个全球哨兵网络来监测新真菌物种的出现和易感性变化的必要性。关于归因死亡率的可靠数据对于设计具有死亡率终点的临床研究至关重要。尽管已建议对有危险因素、不明原因脓毒症和念珠菌血清生物标志物[β-1-> 3-D-葡聚糖（BDG）和白色念珠菌芽管抗体（CAGTA）]阳性的患者进行念珠菌早期抗真菌治疗，但其有效性和对结局的影响仍需证实。未来的研究可能会专门针对腹部念珠菌病患者的最佳诊断和治疗策略。更好地了解抗真菌分子的药代动力学和组织渗透是重症监护医师的关键问题。关于侵袭性曲霉病，需要进一步调查，以确定其发病率在ICU，它与流感爆发的关系，快速诊断的临床影响，以及联合治疗的意义。结论：有关IFI的基本问题必须在未来十年内得到解决。本研究议程中描述的临床研究应为需要进行的临床研究提供模板并设定优先级。
Purpose: To describe concisely the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to Candida and Aspergillus infections in non-neutropenic patients in the ICU setting.Methods: A systematic review of the medical literature taking account of national and international guidelines and expert opinion.Results: Severe invasive fungal infections (IFIs) are becoming increasingly frequent in critically ill patients. Approximately 80% of IFIs are due to Candida spp. and 0.3-19% to Aspergillus spp. Recent observations emphasize the necessity of building a worldwide sentinel network to monitor the emergence of new fungal species and changes in susceptibility. Robust data on the attributable mortality are essential for the design of clinical studies with mortality endpoints. Although early antifungal therapy for Candida has been recommended in patients with risk factors, sepsis of unknown cause, and positive Candida serum biomarkers [beta-1 -> 3-D-glucan (BDG) and Candida albicans germ tube antibody (CAGTA)], its usefulness and influence on outcome need to be confirmed. Future studies may specifically address the optimal diagnostic and therapeutic strategies for patients with abdominal candidiasis. Better knowledge of the pharmacokinetics of antifungal molecules and tissue penetration is a key issue for intensivists. Regarding invasive aspergillosis, further investigation is needed to determine its incidence in the ICU, its relationship with influenza outbreaks, the clinical impact of rapid diagnosis, and the significance of combination treatment.Conclusions: Fundamental questions regarding IFI have to be addressed over the next decade. The clinical studies described in this research agenda should provide a template and set priorities for the clinical investigations that need to be performed.