EPICO 3.0. Management of non-neutropenic patients in medical wards

Fecha de publicación: 31/10/2016

Autores de IIS La Fe

Rafael Zaragoza Crespo

Autor
Miguel Salavert Lletí

Autor

Participantes ajenos a IIS La Fe

Ferrer, R
Rodriguez, AH
Maseda, E
Llinares, P
Grau, S
Alvarez-Lerma, F
Quindos, G
Huarte, R
EPICO Project Grp

Grupos

Infección Grave

Investigador Principal

María Ángeles Tormo Mas

Abstract

Background: Although the management of invasive fungal infection (IFI) has improved, a number of controversies persist regarding the approach to invasive fungal infection in non-neutropenic medical ward patients. Aims: To identify the essential clinical knowledge to elaborate a set of recommendations with a high level of consensus necessary for the management of IFI in non-neutropenic medical ward patients. Methods: A prospective, Spanish questionnaire, which measures consensus through the Delphi technique, was anonymously answered and e-mailed by 30 multidisciplinary national experts, all specialists (intensivists, anesthesiologists, microbiologists, pharmacologists and specialists in infectious diseases) in IFI and belonging to six scientific national societies. They responded to five questions prepared by the coordination group after a thorough review of the literature published in the last few years. For a category to be selected, the level of agreement among the experts in each category had to be equal to or greater than 70%. In a second round, 73 specialists attended a face-to-face meeting held after extracting the recommendations from the chosen topics, and validated the pre-selected recommendations and derived algorithm. Results: The following recommendations were validated and included in the algorithm: 1. several elements were identified as risk factors for invasive candidiasis (IC) in non-hematologic medical patients; 2. no agreement on the use of the colonization index to decide whether prescribing an early antifungal treatment to stable patients (no shock), with sepsis and no other evident focus and IC risk factors; 3. agreement on the use of the Candida Score to decide whether prescribing early antifungal treatment to stable patients (no shock) with sepsis and no other evident focus and IC risk factors; 4. agreement on initiating early antifungal treatment in stable patients (no shock) with a colonization index > 0.4, sepsis with no other evident focus and IC risk factors; 5. agreement on the performance of additional procedures in stable patients (no shock) with sepsis and no other evident focus, IC risk factors, without colonization index >0.4, but with a high degree of suspicion. Conclusions: Based on the expert's recommendations, an algorithm for the management of nonneutropenic medical patients was constructed and validated. This algorithm may be useful to support bedside prescription. (C) 2016 Asociacion Espanola de Micologia. Published by Elsevier Espana, S.L.U. All rights reserved.

Datos de la publicación

ISSN/ISSNe:: 1130-1406, 2173-9188
Tipo:: Article
Páginas:: 216-223
DOI:: 10.1016/j.riam.2016.06.003
Factor de Impacto:: 0,471 SCImago ℠
Cuartil:: Q3 SCImago ℠

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Filiaciones

Ferrer, R:: Vall Hebron Univ Hosp, Shock Organ Dysfunct & Resuscitat Res Grp SODIR, Dept Intens Care, VHIR, Barcelona, Spain
Zaragoza, R:: Dr Peset Univ Hosp, Intens Care Med Serv, Valencia, Spain
Rodriguez, AH:: Joan XXIII Univ Hosp, Intens Care Unit, Tarragona, Spain
Maseda, E:: La Paz Univ Hosp, Anesthesiol Serv, Madrid, Spain
Llinares, P:: A Coruna Univ Complex Hosp, Infect Dis Serv, La Coruna, Spain
Grau, S:: Hosp Mar, Serv Pharm, Barcelona, Spain
Alvarez-Lerma, F:: Hosp Mar, Intens Care Med Serv, Barcelona, Spain
Quindos, G:: Univ Basque Country, Fac Med & Dent, Microbiol Serv, Leioa, Spain
Salavert, M:: Hosp La Fe, Infect Dis Serv, Valencia, Spain
Huarte, R:: Miguel Servet Univ Hosp, Serv Pharm, Zaragoza, Spain