{"id":17072,"date":"2019-05-03T05:27:37","date_gmt":"2019-05-02T21:27:37","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17072"},"modified":"2019-06-02T06:39:41","modified_gmt":"2019-06-01T22:39:41","slug":"intensive-care-med%e5%8f%91%e5%b8%83%e6%8c%87%e5%8d%97-esicm-escmid%e7%89%b9%e5%88%ab%e5%b7%a5%e4%bd%9c%e7%bb%84%e6%9c%89%e5%85%b3%e5%8d%b1%e9%87%8d%e7%97%85%e6%82%a3%e8%80%85%e4%be%b5%e8%a2%ad","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17072","title":{"rendered":"[Intensive Care Med\u53d1\u5e03\u6307\u5357]: ESICM\/ESCMID\u7279\u522b\u5de5\u4f5c\u7ec4\u6709\u5173\u5371\u91cd\u75c5\u60a3\u8005\u4fb5\u88ad\u6027\u5ff5\u73e0\u83cc\u75c5\u8bca\u7597\u7684\u63a8\u8350\u610f\u89c1"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">ESICM\/ESCMID task force on practical management of invasive candidiasis in critically ill patients<\/h1>\n\n\n\n<h2 class=\"wp-block-heading\">Question 1: Can we recommend the use of risk prediction models in daily clinical practice?\u6211\u4eec\u80fd\u5426\u63a8\u8350\u5de5\u4f5c\u4e2d\u91c7\u7528\u98ce\u9669\u9884\u6d4b\u6a21\u578b\uff1f<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Recommendations \u63a8\u8350\u610f\u89c1<\/h2>\n\n\n\n<p>Risk prediction models, because of their simplicity and high negative predictive values, should be used for identifying high-risk patients (Strong recommendation, low-quality evidence).<\/p>\n\n\n\n<p>\u7531\u4e8e\u98ce\u9669\u9884\u6d4b\u6a21\u578b\u7b80\u5355\u4e14\u9634\u6027\u9884\u671f\u503c\u5f88\u9ad8\uff0c\u56e0\u6b64\u53ef\u4ee5\u7528\u4e8e\u9274\u522b\u9ad8\u5371\u60a3\u8005\uff08\u5f3a\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Question 2:  What conventional and non-culture-based microbiological techniques are available for diagnosing IC?\u8bca\u65ad\u4fb5\u88ad\u6027\u5ff5\u73e0\u83cc\u75c5\u6709\u54ea\u4e9b\u4f20\u7edf\u548c\u975e\u57f9\u517b\u5fae\u751f\u7269\u5b66\u6280\u672f\uff1f<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Consensus statements \u5171\u8bc6\u8bf4\u660e<\/h2>\n\n\n\n<p>The panel suggests that when IC is suspected, cultures and microscopic examination should be performed on blood and other body fluids taken from all normally sterile sites (best practice statement).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u5efa\u8bae\uff0c\u5f53\u6000\u7591\u4fb5\u88ad\u6027\u5ff5\u73e0\u83cc\u75c5\u65f6\uff0c\u5e94\u5f53\u5bf9\u8840\u6db2\u548c\u65e0\u83cc\u90e8\u4f4d\u4f53\u6db2\u6807\u672c\u8fdb\u884c\u57f9\u517b\u53ca\u663e\u5fae\u955c\u68c0\u67e5\uff08\u6700\u4f73\u4e34\u5e8a\u5b9e\u8df5\uff09<\/p>\n\n\n\n<p>The panel recommends incorporating conventional and non-culture-based techniques as part of the diagnostic strategy for IC (best practice statement):<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\u5c06\u4f20\u7edf\u53ca\u975e\u57f9\u517b\u6280\u672f\u4f5c\u4e3a\u4fb5\u88ad\u6027\u5ff5\u73e0\u83cc\u75c5\u8bca\u65ad\u7b56\u7565\u7684\u4e00\u90e8\u5206\uff08\u6700\u4f73\u4e34\u5e8a\u5b9e\u8df5\uff09<\/p>\n\n\n\n<ul><li>Conventional culture-based tests (best practice statement).\u4f20\u7edf\u57f9\u517b\uff08\u6700\u4f73\u4e34\u5e8a\u5b9e\u8df5\uff09<\/li><li>PCR-based tests (weak recommendation, low quality of evidence).PCR\u68c0\u67e5\uff08\u5f31\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/li><li>Miniaturized-magnetic resonance-based technology (weak recommendation, low quality of evidence) \u5fae\u578b\u78c1\u5171\u632f\uff08\u5f31\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/li><\/ul>\n\n\n\n<p>Serological tests: \u8840\u6e05\u5b66\u68c0\u67e5<\/p>\n\n\n\n<ul><li>BDG (weak recommendation, moderate quality of evidence) G\u8bd5\u9a8c\uff08\u5f31\u63a8\u8350\uff0c\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\uff09<\/li><li>Mn-Ag and Mn-Ab (weak recommendation, low quality of evidence) \u7518\u9732\u805a\u7cd6\u6297\u539f\u53ca\u7518\u9732\u805a\u7cd6\u6297\u4f53\uff08\u5f31\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/li><li>CAGTA (weak recommendation, low quality of evidence). \u5ff5\u73e0\u83cc\u5c5e\u82bd\u7ba1\u6297\u4f53\uff08\u5f31\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/li><\/ul>\n\n\n\n<p>The panel agrees that PCR-based tests and miniaturized-magnetic resonance-based technology perform well. However, the lack of standardization and of large-scale validation precludes their clinical use without ancillary testing (weak recommendation, low quality of evidence)<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u8ba4\u4e3a\uff0cPCR\u68c0\u67e5\u53ca\u5fae\u578b\u78c1\u5171\u632f\u6280\u672f\u51c6\u786e\u6027\u5f88\u9ad8\u3002\u7136\u800c\uff0c\u7531\u4e8e\u5e76\u975e\u6807\u51c6\u5316\u4e14\u7f3a\u4e4f\u5927\u89c4\u6a21\u8bd5\u9a8c\u9a8c\u8bc1\uff0c\u9650\u5236\u4e86\u5176\u4e34\u5e8a\u5e94\u7528\uff08\u5f31\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<p>The panel agrees that the combined use of Mn-Ag and Mn-Ab, BDG quantification and CAGTA provides added value and that these tests are therefore of clinical utility (weak recommendation, low quality of evidence)<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u8ba4\u4e3a\uff0c\u8054\u5408\u7518\u9732\u805a\u7cd6\u6297\u539f\u548c\u6297\u4f53\u68c0\u6d4b\uff0c\u5b9a\u91cfG\u8bd5\u9a8c\u53ca\u5ff5\u73e0\u83cc\u5c5e\u82bd\u7ba1\u6297\u4f53\u68c0\u6d4b\u5177\u6709\u989d\u5916\u4ef7\u503c\uff0c\u8fd9\u4e9b\u68c0\u67e5\u6709\u4e34\u5e8a\u7528\u9014\uff08\u5f31\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<p>The panel agrees that quantification of BDG has an excellent negative predictive value, and should therefore be used to rule out IC (weak recommendation, low quality of evidence)<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u8ba4\u4e3a\uff0c\u5b9a\u91cfG\u8bd5\u9a8c\u5177\u6709\u5f88\u9ad8\u7684\u9634\u6027\u9884\u671f\u503c\uff0c\u56e0\u800c\u53ef\u7528\u4e8e\u6392\u9664\u4fb5\u88ad\u6027\u5ff5\u73e0\u83cc\u75c5\uff08\u5f31\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<p>The panel recommends that the utility of quantitative detection of fungal biomarkers for identifying IC should be further assessed in large-scale clinical trials (best practice statement).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\uff0c\u5e94\u901a\u8fc7\u5927\u89c4\u6a21\u4e34\u5e8a\u8bd5\u9a8c\u8fdb\u4e00\u6b65\u8bc4\u4ef7\u5b9a\u91cf\u68c0\u6d4b\u771f\u83cc\u751f\u7269\u6807\u5fd7\u7269\u7684\u7528\u9014\uff08\u6700\u4f73\u4e34\u5e8a\u5b9e\u8df5\uff09<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Question 3: Should antifungal prophylaxis be used in critically ill patients? \u5371\u91cd\u75c5\u60a3\u8005\u662f\u5426\u5e94\u5f53\u8fdb\u884c\u6297\u771f\u83cc\u9884\u9632\uff1f<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Consensus statements \u5171\u8bc6\u8bf4\u660e<\/h2>\n\n\n\n<p>The panel recommends against the routine and universal administration of antifungal prophylaxis in critically ill patients (weak recommendation, moderate quality of evidence).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u53cd\u5bf9\u5e38\u89c4\u53ca\u666e\u904d\u5bf9\u5371\u91cd\u75c5\u60a3\u8005\u4f7f\u7528\u771f\u83cc\u9884\u9632\uff08\u5f31\u63a8\u8350\uff0c\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Question 4: Should pre-emptive therapy be used in critically ill patients? \u62a2\u5148\u6cbb\u7597\u662f\u5426\u5e94\u5f53\u7528\u4e8e\u5371\u91cd\u75c5\u60a3\u8005\uff1f<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Consensus statements \u5171\u8bc6\u8bf4\u660e<\/h2>\n\n\n\n<p>The panel does not recommend the use of pre-emptive antifungal therapy in critically ill patients (weak recommendation, low-quality evidence).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u4e0d\u63a8\u8350\u5371\u91cd\u75c5\u60a3\u8005\u8fdb\u884c\u62a2\u5148\u6297\u771f\u83cc\u6cbb\u7597\uff08\u5f31\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<p>The panel agrees that more studies are needed to define the critically ill patient profile that would benefit most from pre-emptive antifungal therapy and whether the widespread use of antifungal agents influences fungal ecology (best practice statement).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u8ba4\u4e3a\uff0c\u9700\u8981\u66f4\u591a\u7814\u7a76\u786e\u5b9a\u53ef\u80fd\u4ece\u62a2\u5148\u6297\u771f\u83cc\u6cbb\u7597\u4e2d\u83b7\u76ca\u6700\u591a\u7684\u5371\u91cd\u75c5\u60a3\u8005\u4eba\u7fa4\uff0c\u4ee5\u53ca\u5e7f\u6cdb\u4f7f\u7528\u6297\u771f\u83cc\u836f\u7269\u662f\u5426\u5f71\u54cd\u771f\u83cc\u751f\u6001\uff08\u6700\u4f73\u4e34\u5e8a\u5b9e\u8df5\uff09<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Question 5: Which patients should receive empirical antifungal treatment? \u54ea\u4e9b\u60a3\u8005\u5e94\u5f53\u63a5\u53d7\u7ecf\u9a8c\u6027\u6297\u771f\u83cc\u6cbb\u7597\uff1f<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Consensus statement \u5171\u8bc6\u8bf4\u660e<\/h2>\n\n\n\n<p>The panel suggests that empirical antifungal therapy might be considered only in patients with septic shock and multi-organ failure (MOF) who have more than 1 extra-digestive site (i.e. urine, mouth, throat, upper and lower respiratory tracts, skin folds, drains, operative site) with proven Candida species colonization (strong recommendation, low quality of evidence).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u5efa\u8bae\uff0c\u4ec5\u5728\u611f\u67d3\u6027\u4f11\u514b\u53ca\u591a\u5668\u5b98\u529f\u80fd\u8870\u7aed(MOF)\u4e14\u9664\u8bc1\u5b9e\u80c3\u80a0\u9053\u5916\u8d85\u8fc7\u4e00\u4e2a\u90e8\u4f4d\uff08\u5373\u5c3f\uff0c\u53e3\u8154\uff0c\u54bd\uff0c\u4e0a\u4e0b\u547c\u5438\u9053\uff0c\u76ae\u80a4\u76b1\u8936\uff0c\u5f15\u6d41\uff0c\u624b\u672f\u90e8\u4f4d\uff09\u6709\u5ff5\u73e0\u83cc\u5b9a\u690d\u7684\u60a3\u8005\uff0c\u5e94\u5f53\u8003\u8651\u8fdb\u884c\u7ecf\u9a8c\u6027\u6297\u771f\u83cc\u6cbb\u7597\uff08\u5f3a\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<p>The panel recommends not starting empirical antifungal therapy in patients without septic shock and MOF (strong recommendation, low quality of evidence).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\u5bf9\u4e8e\u4e0d\u4f34\u6709\u611f\u67d3\u6027\u4f11\u514b\u548cMOF\u7684\u60a3\u8005\uff0c\u4e0d\u5e94\u5f00\u59cb\u7ecf\u9a8c\u6027\u6297\u771f\u83cc\u6cbb\u7597\uff08\u5f3a\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<p>Candida isolation from respiratory samples should be considered as one site of colonization among others and isolation of Candida from the respiratory tract alone should not prompt initiation of treatment. However, this suggestion does not apply to patients with a clear diagnosis of pneumonia despite the presence of fungal colonization in a non-digestive site (best practice statement).<\/p>\n\n\n\n<p>\u547c\u5438\u9053\u6807\u672c\u5206\u79bb\u5230\u5ff5\u73e0\u83cc\u5e94\u5f53\u8003\u8651\u4e3a\u5b9a\u690d\uff0c\u5355\u7eaf\u4ece\u547c\u5438\u9053\u5206\u79bb\u5230\u5ff5\u73e0\u83cc\u4e0d\u5e94\u5f00\u59cb\u6cbb\u7597\u3002\u7136\u800c\uff0c\u8fd9\u4e00\u63a8\u8350\u610f\u89c1\u5e76\u4e0d\u80fd\u7528\u4e8e\u660e\u786e\u8bca\u65ad\u80ba\u708e\u7684\u60a3\u8005\uff0c\u5c3d\u7ba1\u975e\u6d88\u5316\u9053\u90e8\u5206\u6709\u771f\u83cc\u5b9a\u690d\uff08\u6700\u4f73\u4e34\u5e8a\u5b9e\u8df5\uff09<\/p>\n\n\n\n<p>The panel recommends the promotion of antifungal stewardship programs in order to limit the use of empirical therapy. The current practice of indiscriminate use of antifungals may lead to the emergence of resistant strains (best practice statement).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\uff0c\u5e94\u5f53\u666e\u53ca\u6297\u771f\u83cc\u836f\u7269\u76d1\u6d4b\u4ee5\u9650\u5236\u7ecf\u9a8c\u6027\u6cbb\u7597\u3002\u76ee\u524d\u968f\u610f\u4f7f\u7528\u6297\u771f\u83cc\u836f\u7269\u53ef\u80fd\u5bfc\u81f4\u8010\u836f\u83cc\u682a\u7684\u4ea7\u751f\uff08\u6700\u4f73\u4e34\u5e8a\u5b9e\u8df5\uff09<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Question 6: What is the preferred first-line empirical therapy in a non-neutropenic critically ill patient with invasive candidiasis? \u7f79\u60a3\u4fb5\u88ad\u6027\u5ff5\u73e0\u83cc\u75c5\u7684\u975e\u7c92\u7f3a\u5371\u91cd\u75c5\u60a3\u8005\u4e00\u7ebf\u7ecf\u9a8c\u6027\u6cbb\u7597\u836f\u7269\u6709\u54ea\u4e9b\uff1f<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Consensus statement \u5171\u8bc6\u8bf4\u660e<\/h2>\n\n\n\n<p>The panel recommends that echinocandins should be used as the first treatment option in critically ill patients with septic shock and MOF with IC (weak recommendation, low quality of evidence).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\uff0c\u5bf9\u4e8e\u7f79\u60a3\u4fb5\u88ad\u6027\u5ff5\u73e0\u83cc\u75c5\u7684\u611f\u67d3\u6027\u4f11\u514b\u53caMOF\u60a3\u8005\uff0c\u68d8\u767d\u83cc\u7d20\u5e94\u4f5c\u4e3a\u4e00\u7ebf\u6cbb\u7597\u836f\u7269\uff08\u5f31\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<p>The panel recommends that fluconazole should be considered the first treatment option for critically ill patients with low severity of disease (i.e. without septic shock and\/or MOF) in settings with low fluconazole resistance (strong recommendation, low quality of evidence).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\uff0c\u5728\u6c1f\u5eb7\u5511\u8010\u836f\u7387\u8f83\u4f4e\u7684\u60c5\u51b5\u4e0b\uff0c\u5bf9\u4e8e\u75be\u75c5\u4e25\u91cd\u7a0b\u5ea6\u8f83\u4f4e\uff08\u5373\u672a\u5408\u5e76\u611f\u67d3\u6027\u4f11\u514b\u548c\/\u6216MOF\uff09\u7684\u60a3\u8005\uff0c\u6c1f\u5eb7\u5511\u53ef\u4f5c\u4e3a\u4e00\u7ebf\u6cbb\u7597\u836f\u7269\uff08\u5f3a\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<p>The panel recommends that critically ill patients treated with fluconazole should receive a loading dose. A weight-based dosing scheme is recommended (loading dose 12 mg\/kg; maintenance dose 6 mg\/kg) (strong recommendation, low quality of evidence).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\uff0c\u5371\u91cd\u75c5\u60a3\u8005\u63a5\u53d7\u6c1f\u5eb7\u5511\u6cbb\u7597\u65f6\uff0c\u5e94\u5f53\u4f7f\u7528\u8d1f\u8377\u5242\u91cf\u3002\u63a8\u8350\u4f7f\u7528\u57fa\u4e8e\u4f53\u91cd\u7684\u6cbb\u7597\u65b9\u6848\uff08\u8d1f\u8377\u5242\u91cf12 mg\/kg\uff1b\u7ef4\u6301\u5242\u91cf6 mg\/kg\uff09\uff08\u5f3a\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Question 7: What is the role of polyenes in critically ill patients? \u591a\u70ef\u7c7b\u6297\u771f\u83cc\u836f\u7269\u5728\u5371\u91cd\u75c5\u60a3\u8005\u7684\u5730\u4f4d\u5982\u4f55\uff1f<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Consensus statements \u5171\u8bc6\u8bf4\u660e<\/h2>\n\n\n\n<p>The panel recommends that AmB-d should not be used as a first-line treatment in critically ill patients with documented or suspected IC due to its significant nephrotoxicity (strong recommendation, moderate quality of evidence).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\uff0c\u5bf9\u4e8e\u786e\u8bca\u6216\u7591\u4f3c\u4fb5\u88ad\u6027\u5ff5\u73e0\u83cc\u75c5\u7684\u5371\u91cd\u75c5\u60a3\u8005\uff0c\u666e\u901a\u4e24\u6027\u9709\u7d20B\u7531\u4e8e\u80be\u6bd2\u6027\u660e\u663e\uff0c\u4e0d\u80fd\u4f5c\u4e3a\u4e00\u7ebf\u6cbb\u7597\u836f\u7269\uff08\u5f3a\u63a8\u8350\uff0c\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<p>The panel recommends that the use of LF-AmB (liposomal amphotericin B) should be preferred over other lipid formulations when previous treatment with echinocandins and azoles has already failed (strong recommendation, moderate quality of evidence).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\uff0c\u5f53\u68d8\u767d\u83cc\u7d20\u548c\u5511\u7c7b\u6297\u771f\u83cc\u836f\u7269\u5931\u8d25\u65f6\uff0c\u8102\u8d28\u4f53\u4e24\u6027\u9709\u7d20B\u8f83\u5176\u4ed6\u8102\u8d28\u5236\u5242\u4f18\u5148\u4f7f\u7528\uff08\u5f3a\u63a8\u8350\uff0c\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Question 8: In non-neutropenic critically ill patients, does de-escalation of antifungal therapy yield similar outcomes (in terms of clinical success and mortality) as ongoing treatment with first-line antifungal agents? \u5bf9\u4e8e\u975e\u7c92\u7f3a\u5371\u91cd\u75c5\u60a3\u8005\uff0c\u4e0e\u7ee7\u7eed\u4f7f\u7528\u4e00\u7ebf\u6297\u771f\u83cc\u836f\u7269\u76f8\u6bd4\uff0c\u964d\u9636\u68af\u6297\u771f\u83cc\u6cbb\u7597\u80fd\u5426\u53d6\u5f97\u76f8\u4f3c\u9884\u540e\uff08\u4e34\u5e8a\u6210\u529f\u7387\u53ca\u75c5\u6b7b\u7387\uff09\uff1f<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Consensus statement \u5171\u8bc6\u8bf4\u660e<\/h2>\n\n\n\n<p>The panel recommends de-escalating from an echinocandin to fluconazole when the patient is clinically stable and the isolate is susceptible to fluconazole (Strong recommendation, moderate quality of evidence.)<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\uff0c\u5f53\u60a3\u8005\u75c5\u60c5\u5e73\u7a33\u4e14\u5206\u79bb\u83cc\u682a\u5bf9\u6c1f\u5eb7\u5511\u654f\u611f\u65f6\uff0c\u5e94\u5f53\u4ece\u68d8\u767d\u83cc\u7d20\u964d\u9636\u68af\u81f3\u6c1f\u5eb7\u5511\uff08\u5f3a\u63a8\u8350\uff0c\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<p>Echinocandins should not be de-escalated if central venous catheter or any other foreign material has not been removed. This recommendation is particularly pertinent to cases with an intravascular catheter that cannot be removed or if an intravascular device (e.g. pacemaker) must be left in place. (strong recommendation, moderate quality of evidence).<\/p>\n\n\n\n<p>\u5982\u679c\u672a\u62d4\u9664\u4e2d\u5fc3\u9759\u8109\u5bfc\u7ba1\u6216\u5176\u4ed6\u5f02\u7269\uff0c\u4e0d\u5e94\u5bf9\u68d8\u767d\u83cc\u7d20\u964d\u9636\u68af\u3002\u8fd9\u4e00\u63a8\u8350\u610f\u89c1\u5c24\u5176\u9002\u7528\u4e8e\u65e0\u6cd5\u62d4\u9664\u8840\u7ba1\u5185\u5bfc\u7ba1\u6216\u5fc5\u987b\u4fdd\u7559\u8840\u7ba1\u5185\u88c5\u7f6e\uff08\u5982\u8d77\u640f\u5668\uff09\u7684\u60c5\u51b5\uff08\u5f3a\u63a8\u8350\uff0c\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<p>The panel recommends that antifungal treatment should be stopped in patients with suspected (but not proven) IC with negative blood cultures and\/or other negative culture specimens taken from suspected infectious foci before starting antifungal therapy (best practice statement).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\uff0c\u5bf9\u4e8e\u7591\u4f3c\uff08\u672a\u786e\u8bca\uff09\u4fb5\u88ad\u6027\u5ff5\u73e0\u83cc\u611f\u67d3\u60a3\u8005\uff0c\u82e5\u5f00\u59cb\u6297\u771f\u83cc\u6cbb\u7597\u524d\u7559\u53d6\u7684\u8840\u57f9\u517b\u9634\u6027\uff0c\u6216\u5176\u4ed6\u53ef\u7591\u611f\u67d3\u90e8\u4f4d\u6807\u672c\u57f9\u517b\u7ed3\u679c\u9634\u6027\uff0c\u5e94\u505c\u6b62\u6297\u771f\u83cc\u6cbb\u7597\uff08\u6700\u4f73\u4e34\u5e8a\u5b9e\u8df5\uff09<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Question 9: What is the recommended duration of antifungal treatment in patients with candidemia and IC? \u5bf9\u4e8e\u5ff5\u73e0\u83cc\u8840\u75c7\u53ca\u4fb5\u88ad\u6027\u5ff5\u73e0\u83cc\u75c5\u60a3\u8005\uff0c\u63a8\u8350\u7684\u6297\u771f\u83cc\u6cbb\u7597\u7597\u7a0b\u5982\u4f55\uff1f<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Consensus statement \u5171\u8bc6\u8bf4\u660e<\/h2>\n\n\n\n<p>The panel recommends that candidemia should be treated for at least 14 days after the first negative blood culture (strong recommendation, low quality of evidence).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\uff0c\u5ff5\u73e0\u83cc\u8840\u75c7\u5e94\u5f53\u5728\u9996\u6b21\u8840\u57f9\u517b\u9634\u6027\u540e\u6cbb\u7597\u81f3\u5c1114\u5929\uff08\u5f3a\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<p>The panel suggests that IC without positive blood cultures should be treated for 10\u201314 days (weak recommendation, low quality of evidence).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\uff0c\u4fb5\u88ad\u6027\u5ff5\u73e0\u83cc\u75c5\u4e0d\u4f34\u8840\u57f9\u517b\u9633\u6027\u65f6\uff0c\u5e94\u5f53\u6cbb\u759710-14\u5929\uff08\u5f31\u63a8\u8350\uff0c\u4f4e\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<p>The panel recommends that adequate source control (catheter removal, appropriate drainage, surgical control) should be performed early, if clinically feasible, in every critically ill patient with IC (strong recommendation, moderate quality of evidence).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\uff0c\u5bf9\u4e8e\u4fb5\u88ad\u6027\u5ff5\u73e0\u83cc\u75c5\u7684\u5371\u91cd\u75c5\u60a3\u8005\uff0c\u5982\u679c\u4e34\u5e8a\u60c5\u51b5\u8bb8\u53ef\uff0c\u5e94\u5c3d\u65e9\u8fdb\u884c\u5145\u5206\u7684\u611f\u67d3\u7076\u63a7\u5236\uff08\u62d4\u9664\u5bfc\u7ba1\uff0c\u9002\u5f53\u5f15\u6d41\uff0c\u624b\u672f\u63a7\u5236\uff09\uff08\u5f3a\u63a8\u8350\uff0c\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n\n\n\n<p>The panel recommends that in critically ill patients with IC and inadequate source control, the treatment duration for deep-seated infection due to Candida species (including endocarditis) should be individualized and based on a multidisciplinary approach (best practice statement).<\/p>\n\n\n\n<p>\u5c0f\u7ec4\u63a8\u8350\uff0c\u5bf9\u4e8e\u65e0\u6cd5\u8fdb\u884c\u5145\u5206\u611f\u67d3\u7076\u63a7\u5236\u7684\u4fb5\u88ad\u6027\u5ff5\u73e0\u83cc\u75c5\u5371\u91cd\u60a3\u8005\uff0c\u5ff5\u73e0\u83cc\u5c5e\u5bfc\u81f4\u7684\u6df1\u90e8\u611f\u67d3\uff08\u5305\u62ec\u5fc3\u5185\u819c\u708e\uff09\u7684\u7597\u7a0b\u5e94\u5f53\u4e2a\u4f53\u5316\uff0c\u5e76\u57fa\u4e8e\u591a\u5b66\u79d1\u7b56\u7565\uff08\u6700\u4f73\u4e34\u5e8a\u5b9e\u8df5\uff09<\/p>\n\n\n\n<p>In cases where an intravascular catheter or any other foreign material cannot be removed, echinocandins should not be de-escalated to an azole because of their enhanced activity against biofilm (best practice statement).<\/p>\n\n\n\n<p>\u82e5\u65e0\u6cd5\u53bb\u9664\u8840\u7ba1\u5185\u5bfc\u7ba1\u6216\u5176\u4ed6\u5f02\u7269\uff0c\u7531\u4e8e\u68d8\u767d\u83cc\u7d20\u5177\u6709\u8f83\u5f3a\u7684\u6297\u751f\u7269\u819c\u6d3b\u6027\uff0c\u4e0d\u5e94\u964d\u9636\u68af\u5230\u5511\u7c7b\uff08\u6700\u4f73\u4e34\u5e8a\u5b9e\u8df5\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"<p>ESICM\/ESCMID task force on practical management of inva [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[25,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17072"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17072"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17072\/revisions"}],"predecessor-version":[{"id":17075,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17072\/revisions\/17075"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17072"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17072"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17072"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}