2021 年侵袭性曲霉病诊断和管理共识指南。,Internal Medicine Journal

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2021 年侵袭性曲霉病诊断和管理共识指南。
Internal Medicine Journal ( IF 1.8 ) Pub Date : 2021-11-01 , DOI: 10.1111/imj.15591
Abby P Douglas _{1,

2,

3,

4} , Olivia C Smibert _{1,

2,

3,

4} , Ashish Bajel _{2,

5} , Catriona L Halliday _{6,

7} , Orly Lavee ₈ , Brendan McMullan _{3,

9,

10} , Michelle K Yong _{1,

2,

3,

11} , Sebastiaan J van Hal _{12,

13} , Sharon C-A Chen _{6,

7,

12} ,

Affiliation

Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.
Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, New South Wales, Australia.
Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia.
Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia.
Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.
School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

血液学/肿瘤学患者的侵袭性曲霉病 (IA) 表现为原发性感染或突破性感染，可能对抗真菌治疗无效，并且相关死亡率很高。其他新出现的患者风险组包括重症监护室中患有严重呼吸道病毒感染的患者，包括 COVID-19。鉴于自 2014 年之前的指南以来的知识进步，这些指南提出了关键的诊断和治疗建议。基于培养和组织学的方法仍然是 IA 诊断的核心。越来越多的证据表明，使用真菌生物标志物的非培养方法可用于先发制人的感染筛查，以及联合使用时用于 IA 诊断。尽管唑类耐药性在澳大利亚似乎并不常见，建议对临床烟曲霉复合分离物进行药敏试验。伏立康唑仍然是治疗原发性 IA（包括肺外疾病）的首选一线抗真菌药物。儿科治疗的建议大致遵循成人的建议。对于突破性和难治性 IA，强烈建议改变抗真菌药物的类别，并且可能需要考虑临床试验中的药物。更新的基于免疫学的成像方式值得进一步研究，而对 IA 和抗真菌耐药性的监测对于告知当前治疗建议的相关性仍然至关重要。儿科治疗的建议大致遵循成人的建议。对于突破性和难治性 IA，强烈建议改变抗真菌药物的类别，并且可能需要考虑临床试验中的药物。更新的基于免疫学的成像方式值得进一步研究，而对 IA 和抗真菌耐药性的监测对于告知当前治疗建议的相关性仍然至关重要。儿科治疗的建议大致遵循成人的建议。对于突破性和难治性 IA，强烈建议改变抗真菌药物的类别，并且可能需要考虑临床试验中的药物。更新的基于免疫学的成像方式值得进一步研究，而对 IA 和抗真菌耐药性的监测对于告知当前治疗建议的相关性仍然至关重要。

"点击查看英文标题和摘要"

Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021.

Invasive aspergillosis (IA) in haematology/oncology patients presents as primary infection or breakthrough infection, which can become refractory to antifungal treatment and has a high associated mortality. Other emerging patient risk groups include patients in the intensive care setting with severe respiratory viral infections, including COVID-19. These guidelines present key diagnostic and treatment recommendations in light of advances in knowledge since the previous guidelines in 2014. Culture and histological-based methods remain central to the diagnosis of IA. There is increasing evidence for the utility of non-culture methods employing fungal biomarkers in pre-emptive screening for infection, as well as for IA diagnosis when used in combination. Although azole resistance appears to be uncommon in Australia, susceptibility testing of clinical Aspergillus fumigatus complex isolates is recommended. Voriconazole remains the preferred first-line antifungal agent for treating primary IA, including for extrapulmonary disease. Recommendations for paediatric treatment broadly follow those for adults. For breakthrough and refractory IA, a change in class of antifungal agent is strongly recommended, and agents under clinical trial may need to be considered. Newer immunological-based imaging modalities warrant further study, while surveillance for IA and antifungal resistance remain essential to informing the relevance of current treatment recommendations.

更新日期：2021-11-01

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