BACKGROUND The incidence of invasive fungal infections is increasing in immune-competent and immune-compromised patients. An examination of the recent literature related to the treatment of fungal infections was performed to address two clinical questions. First, in patients with proven or probable invasive pulmonary aspergillosis, should combination therapy with a mold-active triazole plus echinocandin be administered vs. mold-active triazole monotherapy? Second, in critically ill patients at risk for invasive candidiasis who are non-neutropenic and are not transplant recipients, should systemic antifungal agents be administered either as prophylaxis or as empiric therapy? METHODS A multidisciplinary panel reviewed the available data concerning the two questions. The evidence was evaluated, and recommendations were generated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS A conditional recommendation was made for patients with proven or probable invasive pulmonary aspergillosis to receive either initial combination therapy with a mold-active triazole plus an echinocandin or initial mold-active triazole monotherapy based on low-quality evidence. Further, a conditional weak recommendation was made against routine administration of prophylactic or empiric antifungal agents targeting Candida species for critically ill patients without neutropenia or a history of transplant based on low-quality evidence. CONCLUSIONS The recommendations presented in these Guidelines are the result of an analysis of currently available evidence. Additional research and new clinical data will prompt an update in the future.

中文翻译：

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侵袭性肺曲霉病的治疗以及成人肺病和重症监护患者侵袭性念珠菌病的预防和经验性治疗。美国胸科学会官方临床实践指南。


背景 侵袭性真菌感染的发生率在免疫功能正常和免疫功能低下患者中呈上升趋势。对与真菌感染治疗相关的最新文献进行了检查，以解决两个临床问题。首先，对于确诊或疑似侵袭性肺曲霉菌病的患者，是否应该使用霉菌活性三唑加棘白菌素的联合治疗，还是使用霉菌活性三唑单药治疗？其次，对于有侵袭性念珠菌病风险的危重患者，如果患者是非中性粒细胞减少且未接受移植的患者，应将全身性抗真菌药物作为预防性治疗还是作为经验性治疗？方法 一个多学科小组审查了有关这两个问题的现有数据。对证据进行评估，并使用建议分级、评估、开发和评估 （GRADE） 方法生成建议。结果 基于低质量证据，有条件地建议确诊或疑似侵袭性肺曲霉病患者接受霉菌活性三唑加棘白菌素的初始联合治疗或初始霉菌活性三唑单药治疗。此外，基于低质量证据，对没有中性粒细胞减少症或移植史的危重患者，提出了有条件的弱建议，反对常规使用针对念珠菌属的预防性或经验性抗真菌药物。结论 这些指南中提出的建议是对当前可用证据的分析结果。额外的研究和新的临床数据将促使未来更新。