Practical guidelines for the diagnosis, prevention and treatment of invasive fungal infection post burn injury in China: 2024 edition
-
摘要: 烧伤患者是侵袭性真菌感染的高发人群。近年来,侵袭性真菌感染在烧伤人群中的发病率呈升高趋势,并日益成为严重烧伤患者死亡的重要原因之一。中国医疗保健国际交流促进会烧伤医学分会、《中华烧伤与创面修复杂志》编辑委员会共同发起并组织多学科专家,基于目前的循证医学证据、临床实践和其他学科权威指南,对《烧伤侵袭性真菌感染诊断与防治指南（2012版）》进行了修订,以期进一步规范烧伤侵袭性真菌感染的临床诊断与治疗。Abstract: Burn patients are at high risk for invasive fungal infections. The incidence of invasive fungal infection for burn victims is increasing dramatically during recent years and becoming one of the major causes of death in patients with severe burns. This updated guideline was initiated and organized by Burn Medicine Branch of China International Exchange and Promotion Association for Medical and Healthcare, and Editorial Committee of Chinese Journal of Burns and Wounds. Based on the current evidence-based medical evidence, clinical practice, and authoritative guidelines from other disciplines, we updated and revised the Guidelines for the diagnosis, prevention and treatment of invasive fungal infections post burn injury (2012 edition), aiming to further standardize the diagnosis, prevention and treatment of invasive fungal infection post burns.
-
Key words:
- Burns /
- Invasive fungal infections /
- Diagnosis /
- Clinical protocols /
- Guideline
-
参考文献
(147) [1] RenauEscrig AI,SalavertM,VivóC,et al.Candidemia in major burns patients[J].Mycoses,2016,59(6):391-398.DOI: 10.1111/myc.12488. [2] RafikA,DiouriM,BahecharN,et al.Epidemiology of nosocomial fungal infections in the National Center for Burns in Casablanca, Morocco[J].Ann Burns Fire Disasters,2016,29(2):90-93. [3] 惠雷,郭春,李继洋,等.重度烧伤患者侵袭性真菌感染情况回顾性分析研究[J].中华医院感染学杂志,2018,28(9):1320-1323.DOI: 10.11816/cn.ni.2018-172754. [4] 《中华烧伤杂志》编辑委员会.烧伤侵袭性真菌感染诊断与防治指南(2012版)[J].中华烧伤杂志,2012,28(2):81-86.DOI: 10.3760/cma.j.issn.1009-2587.2012.02.001. [5] 中华医学会器官移植学分会,中国医师协会器官移植医师分会.中国实体器官移植受者侵袭性真菌病临床诊治指南(2016年版)[J].中华器官移植杂志,2016,37(5):300-305.DOI: 10.3760/cma.j.issn.0254-1785.2016.05.09. [6] 中国成人念珠菌病诊断与治疗专家共识组.中国成人念珠菌病诊断与治疗专家共识[J].中华内科杂志,2020,59(1):5-17.DOI: 10.3760/cma.j.issn.0578-1426.2020.01.002. [7] 中华医学会重症医学分会.重症患者侵袭性真菌感染诊断与治疗指南(2007)[J].中华内科杂志,2007,46(11):960-966.DOI: 10.3760/j.issn:0578-1426.2007.11.031. [8] UllmannAJ,AguadoJM,Arikan-AkdagliS,et al.Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline[J].Clin Microbiol Infect,2018,24Suppl 1:e1-e38.DOI: 10.1016/j.cmi.2018.01.002. [9] CornelyOA,Alastruey-IzquierdoA,ArenzD,et al.Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium[J].Lancet Infect Dis,2019,19(12):e405-e421.DOI: 10.1016/S1473-3099(19)30312-3. [10] BassettiM,AzoulayE,KullbergBJ,et al.EORTC/MSGERC definitions of invasive fungal diseases: summary of activities of the Intensive Care Unit Working Group[J].Clin Infect Dis,2021,72(Suppl 2):S121-127.DOI: 10.1093/cid/ciaa1751. [11] Van BangBN,Thanh XuanN,XuanQuang D,et al.Prevalence, species distribution, and risk factors of fungal colonization and infection in patients at a burn intensive care unit in Vietnam[J].Curr Med Mycol,2020,6(3):42-49.DOI: 10.18502/cmm.6.3.4664. [12] Invasive candidiasis[J].Nat Rev Dis Primers,2024,10(1):21.DOI: 10.1038/s41572-024-00510-4. [13] LinYL,ChenIC,YenJH,et al.Invasive candidiasis in hospitalized patients with major burns[J].J Pers Med,2022,12(1):47.DOI: 10.3390/jpm12010047. [14] StruckMF,GilleJ.Fungal infections in burns: a comprehensive review[J].Ann Burns Fire Disasters,2013,26(3):147-153. [15] SarabahiS,TiwariVK,AroraS,et al.Changing pattern of fungal infection in burn patients[J].Burns,2012,38(4):520-528.DOI: 10.1016/j.burns.2011.09.013. [16] 王仁坤,李叶扬,秦娟,等.烧伤患者真菌感染特点分析[J].广东医学,2011,32(10):1290-1292.DOI: 10.3969/j.issn.1001-9448.2011.10.026. [17] CapoorMR,SarabahiS,TiwariVK,et al.Fungal infections in burns: diagnosis and management[J].Indian J Plast Surg,2010,43(Suppl):S37-42.DOI: 10.4103/0970-0358.70718. [18] ZhouJ,TanJ,GongY,et al.Candidemia in major burn patients and its possible risk factors: a 6-year period retrospective study at a burn ICU[J].Burns,2019,45(5):1164-1171.DOI: 10.1016/j.burns.2019.01.005. [19] MarchettiO,BilleJ,FluckigerU,et al.Epidemiology of candidemia in Swiss tertiary care hospitals: secular trends, 1991-2000[J].Clin Infect Dis,2004,38(3):311-320.DOI: 10.1086/380637. [20] HaJF,ItalianoCM,HeathCH,et al.Candidemia and invasive candidiasis: a review of the literature for the burns surgeon[J].Burns,2011,37(2):181-195.DOI: 10.1016/j.burns.2010.01.005. [21] 张成,龚雅利,罗小强,等.重度烧伤患者真菌血流感染的病原学特征分析[J].中华烧伤杂志,2020,36(1):37-41.DOI: 10.3760/cma.j.issn.1009-2587.2020.01.007. [22] LuoG,PengY,YuanZ,et al.Yeast from burn patients at a major burn centre of China[J].Burns,2011,37(2):299-303.DOI: 10.1016/j.burns.2010.03.004. [23] SchaalJV,LeclercT,SolerC,et al.Epidemiology of filamentous fungal infections in burned patients: a French retrospective study[J].Burns,2015,41(4):853-863.DOI: 10.1016/j.burns.2014.10.024. [24] KatzT,WasiakJ,ClelandH,et al.Incidence of non-candidal fungal infections in severe burn injury: an Australian perspective[J].Burns,2014,40(5):881-886.DOI: 10.1016/j.burns.2013.11.025. [25] DevauchelleP,JeanneM,FréalleE.Mucormycosis in burn patients[J].J Fungi (Basel),2019,5(1):25.DOI: 10.3390/jof5010025. [26] CochranA,MorrisSE,EdelmanLS,et al.Systemic Candida infection in burn patients: a case-control study of management patterns and outcomes[J].Surg Infect (Larchmt),2002,3(4):367-374.DOI: 10.1089/109629602762539580. [27] VinsonneauC,BenyaminaM,BaixenchMT,et al.Effects of candidaemia on outcome of burns[J].Burns,2009,35(4):561-564.DOI: 10.1016/j.burns.2008.05.028. [28] MaurelV,DenisB,CambyM,et al.Outcome and characteristics of invasive fungal infections in critically ill burn patients: a multicenter retrospective study[J].Mycoses,2020,63(6):535-542.DOI: 10.1111/myc.13068. [29] SheridanRL,WeberJM,BudkevichLG,et al.Candidemia in the pediatric patient with burns[J].J Burn Care Rehabil,1995,16(4):440-443.DOI: 10.1097/00004630-199507000-00011. [30] DangJ,GoelP,ChoiKJ,et al.Mucormycosis following burn injuries: a systematic review[J].Burns,2023,49(1):15-25.DOI: 10.1016/j.burns.2022.05.012. [31] DudoignonE,AlanioA,AnsteyJ,et al.Outcome and potentially modifiable risk factors for candidemia in critically ill burns patients: a matched cohort study[J].Mycoses,2019,62(3):237-246.DOI: 10.1111/myc.12872. [32] 唐远洋,罗高兴,贺伟峰.严重烧伤感染后细胞因子风暴发生发展机制浅析[J].四川大学学报(医学版),2021,52(1):16-21.DOI: 10.12182/20210160206. [33] Papadimitriou-OlivgerisM,SpiliopoulouA,FligouF,et al.Risk factors and predictors of mortality of candidaemia among critically ill patients: role of antifungal prophylaxis in its development and in selection of non-albicans species[J].Infection,2017,45(5):651-657.DOI: 10.1007/s15010-017-1050-z. [34] BlumbergHM,JarvisWR,SoucieJM,et al.Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey[J].Clin Infect Dis,2001,33(2):177-186.DOI: 10.1086/321811. [35] EnochDA,LudlamHA,BrownNM.Invasive fungal infections: a review of epidemiology and management options[J].J Med Microbiol,2006,55(Pt 7):809-818.DOI: 10.1099/jmm.0.46548-0. [36] LiYT,WangYC,YangSF,et al.Risk factors and prognoses of invasive Candida infection in surgical critical ill patients with perforated peptic ulcer[J].J Microbiol Immunol Infect,2022,55(4):740-748.DOI: 10.1016/j.jmii.2022.03.001. [37] FochtmannA,ForstnerC,HagmannM,et al.Predisposing factors for candidemia in patients with major burns[J].Burns,2015,41(2):326-332.DOI: 10.1016/j.burns.2014.07.004. [38] G V,T R,A R,et al.Traumatic mucormycosis caused by Apophysomyces species - a case series[J].J Orthop,2023,42:13-16.DOI: 10.1016/j.jor.2023.06.008. [39] LeroyO,GangneuxJP,MontraversP,et al.Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006)[J].Crit Care Med,2009,37(5):1612-1618.DOI: 10.1097/CCM.0b013e31819efac0. [40] MooreEC,PadiglioneAA,WasiakJ,et al.Candida in burns: risk factors and outcomes[J].J Burn Care Res,2010,31(2):257-263.DOI: 10.1097/BCR.0b013e3181d0f536. [41] Thomas-RüddelDO,SchlattmannP,PletzM,et al.Risk factors for invasive Candida infection in critically ill patients: a systematic review and meta-analysis[J].Chest,2022,161(2):345-355.DOI: 10.1016/j.chest.2021.08.081. [42] ZhongL,DongZ,LiuF,et al.Incidence, clinical characteristics, risk factors and outcomes of patients with mixed Candida/bacterial bloodstream infections: a retrospective study[J].Ann Clin Microbiol Antimicrob,2022,21(1):45.DOI: 10.1186/s12941-022-00538-y. [43] StillJMJr, BelcherK, LawEJ. Management of Candida septicaemia in a regional burn unit[J]. Burns, 1995,21(8):594-596. DOI: 10.1016/0305-4179(95)00069-n. [44] JensenJU,HeinL,LundgrenB,et al.Invasive candida infections and the harm from antibacterial drugs in critically ill patients: data from a randomized, controlled trial to determine the role of ciprofloxacin, piperacillin-tazobactam, meropenem, and cefuroxime[J].Crit Care Med,2015,43(3):594-602.DOI: 10.1097/CCM.0000000000000746. [45] LewisRE,KontoyiannisDP.Invasive aspergillosis in glucocorticoid-treated patients[J].Med Mycol,2009,47Suppl 1:S271-281.DOI: 10.1080/13693780802227159. [46] KleinJ,RelloJ,DimopoulosG,et al.Invasive pulmonary aspergillosis in solid-organ transplant patients in the intensive care unit[J].Transpl Infect Dis,2022,24(1):e13746.DOI: 10.1111/tid.13746. [47] DrewniakA,GazendamRP,ToolAT,et al.Invasive fungal infection and impaired neutrophil killing in human CARD9 deficiency[J].Blood,2013,121(13):2385-2392.DOI: 10.1182/blood-2012-08-450551. [48] 李德绘.烧伤病人真菌感染21例分析[J].广西医科大学学报,2003,20(4):599.DOI: 10.3969/j.issn.1005-930X.2003.04.081. [49] 杨晓东,赵广贺,焦秋云,等.精神神经症状在烧伤脓毒症病原菌初步判断中的意义[J].中华烧伤杂志,2007,23(6):459.DOI: 10.3760/cma.j.issn.1009-2587.2007.06.022. [50] 吴祖煌,刘敏,占新华.烧伤患者肺部真菌感染防治的临床体会[J].实用医学杂志,2003,19(2):145.DOI: 10.3969/j.issn.1006-5725.2003.02.055. [51] 那岩,马佳,张兢.14例大面积烧伤患者真菌感染分析[J].中华医院感染学杂志,2003,13(10):940-940.DOI: 10.3321/j.issn:1005-4529.2003.10.014. [52] 宫坤,李俊芳,王志斌.真菌感染致感染性心内膜炎及心肌脓肿超声表现1例[J].中国超声医学杂志,2017,33(4):380.DOI: 10.3969/j.issn.1002-0101.2017.04.035. [53] DonnellyJP,ChenSC,KauffmanCA,et al.Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium[J].Clin Infect Dis,2020,71(6):1367-1376.DOI: 10.1093/cid/ciz1008. [54] ContouD,DorisonM,RosmanJ,et al.Aspergillus-positive lower respiratory tract samples in patients with the acute respiratory distress syndrome: a 10-year retrospective study[J].Ann Intensive Care,2016,6(1):52.DOI: 10.1186/s13613-016-0156-2. [55] AlexanderBD,LamothF,HeusselCP,et al.Guidance on imaging for invasive pulmonary aspergillosis and mucormycosis: from the Imaging Working Group for the Revision and Update of the Consensus Definitions of Fungal Disease from the EORTC/MSGERC[J].Clin Infect Dis,2021,72(Suppl 2):S79-88.DOI: 10.1093/cid/ciaa1855. [56] HageCA,CarmonaEM,EvansSE,et al.Summary for clinicians: microbiological laboratory testing in the diagnosis of fungal infections in pulmonary and critical care practice[J].Ann Am Thorac Soc,2019,16(12):1473-1477.DOI: 10.1513/AnnalsATS.201908-582CME. [57] 季淑娟,倪玲红,张俊丽,等.不同荚膜抗原检测方法对隐球菌脑膜脑炎诊断和疗效评估的价值[J].中华医学杂志,2015,95(46):3733-3736.DOI: 10.3760/cma.j.issn.0376-2491.2015.46.003. [58] ArmstrongAE,RossoffJ,HollemonD,et al.Cell-free DNA next-generation sequencing successfully detects infectious pathogens in pediatric oncology and hematopoietic stem cell transplant patients at risk for invasive fungal disease[J].Pediatr Blood Cancer,2019,66(7):e27734.DOI: 10.1002/pbc.27734. [59] KaitaY,TaruiT,OtsuA,et al.The clinical significance of serum 1,3-β-D-glucan for the diagnosis of candidemia in severe burn patients[J].J Burn Care Res,2019,40(1):104-106.DOI: 10.1093/jbcr/iry055. [60] LeeN,KymD.Clinical Usefulness of Serum (1,3)-β-D-glucan to predict invasive candidiasis in patients with severe burn trauma[J].J Microbiol Immunol Infect,2022,55(1):138-146.DOI: 10.1016/j.jmii.2021.02.004. [61] SkubicJ,TaghaviS,Castillo-AngelesM,et al.Detecting invasive fungal disease in surgical patients: utility of the (13)- β-d-glucan assay[J].Surg Infect (Larchmt),2020,21(5):461-464.DOI: 10.1089/sur.2019.247. [62] 中国医药教育协会真菌病专业委员会,国家皮肤与免疫疾病临床医学研究中心(北京大学第一医院),国家血液疾病临床医学研究中心(北京大学人民医院).侵袭性真菌病实验室诊断方法临床应用专家共识[J].中华内科杂志,2022,61(2):134-141.DOI: 10.3760/cma.j.cn112138-20210530-00383. [63] HorvathJA,DummerS.The use of respiratory-tract cultures in the diagnosis of invasive pulmonary aspergillosis[J].Am J Med,1996,100(2):171-178.DOI: 10.1016/s0002-9343(97)89455-7. [64] LiZ,JiangC,DongD,et al.The correlation between candida colonization of distinct body sites and invasive candidiasis in emergency intensive care units: statistical and molecular biological analysis[J].Mycopathologia,2016,181(7/8):475-484.DOI: 10.1007/s11046-016-9991-9. [65] ColodnerR,NuriY,ChazanB,et al.Community-acquired and hospital-acquired candiduria: comparison of prevalence and clinical characteristics[J].Eur J Clin Microbiol Infect Dis,2008,27(4):301-305.DOI: 10.1007/s10096-007-0438-6. [66] MishraM,AgrawalS,RautS,et al.Profile of yeasts isolated from urinary tracts of catheterized patients[J].J Clin Diagn Res,2014,8(2):44-46.DOI: 10.7860/JCDR/2014/6614.4003. [67] WarkentienTE,ShaikhF,WeintrobAC,et al.Impact of mucorales and other invasive molds on clinical outcomes of polymicrobial traumatic wound infections[J].J Clin Microbiol,2015,53(7):2262-2270.DOI: 10.1128/JCM.00835-15. [68] RodriguezC,WeintrobAC,DunneJR,et al.Clinical relevance of mold culture positivity with and without recurrent wound necrosis following combat-related injuries[J].J Trauma Acute Care Surg,2014,77(5):769-773.DOI: 10.1097/TA.0000000000000438. [69] JonesME,FoxAJ,BarnesAJ,et al.PCR-ELISA for the early diagnosis of invasive pulmonary aspergillus infection in neutropenic patients[J].J Clin Pathol,1998,51(9):652-656.DOI: 10.1136/jcp.51.9.652. [70] WangC,YouZ,FuJ,et al.Application of metagenomic next-generation sequencing in the diagnosis of pulmonary invasive fungal disease[J].Front Cell Infect Microbiol,2022,12:949505.DOI: 10.3389/fcimb.2022.949505. [71] LegrandM,Gits-MuselliM,BoutinL,et al.Detection of circulating mucorales DNA in critically ill burn patients: preliminary report of a screening strategy for early diagnosis and treatment[J].Clin Infect Dis,2016,63(10):1312-1317.DOI: 10.1093/cid/ciw563. [72] PowderlyWG,CloudGA,DismukesWE,et al.Measurement of cryptococcal antigen in serum and cerebrospinal fluid: value in the management of AIDS-associated cryptococcal meningitis[J].Clin Infect Dis,1994,18(5):789-792.DOI: 10.1093/clinids/18.5.789. [73] TuY,LineaweaverWC,BrelandA,et al.Fungal infection in burn patents: a review of 36 case reports[J].Ann Plast Surg,2021,86(4S Suppl 4):S463-467.DOI: 10.1097/SAP.0000000000002865. [74] 王琦,吴海波,许璐璐,等.六胺银滴染法在真菌检测中的应用[J].临床与实验病理学杂志,2021,37(7):865-866.DOI: 10.13315/j.cnki.cjcep.2021.07.025. [75] van BurikJA, ColvenR, SpachDH. Cutaneous aspergillosis[J]. J Clin Microbiol, 1998,36(11):3115-3121. DOI: 10.1128/JCM.36.11.3115-3121.1998. [76] Vitrat-HinckyV,LebeauB,BozonnetE,et al.Severe filamentous fungal infections after widespread tissue damage due to traumatic injury: six cases and review of the literature[J].Scand J Infect Dis,2009,41(6/7):491-500.DOI: 10.1080/00365540902856537. [77] BlythDM,ChungKK,CancioLC,et al.Clinical utility of fungal screening assays in adults with severe burns[J].Burns,2013,39(3):413-419.DOI: 10.1016/j.burns.2012.08.009. [78] PappasPG,ChenSC,DonnellyJP.The evidence supporting the revised EORTC/MSGERC definitions for invasive fungal infections[J].Clin Infect Dis,2021,72(Suppl 2):S77-78.DOI: 10.1093/cid/ciaa1765. [79] StomaI,KarpovI,UssA,et al.Combination of sepsis biomarkers may indicate an invasive fungal infection in haematological patients[J].Biomarkers,2019,24(4):401-406.DOI: 10.1080/1354750X.2019.1600023. [80] DouYH,DuJK,LiuHL,et al.The role of procalcitonin in the identification of invasive fungal infection-a systemic review and meta-analysis[J].Diagn Microbiol Infect Dis,2013,76(4):464-469.DOI: 10.1016/j.diagmicrobio.2013.04.023. [81] CalandraT,RobertsJA,AntonelliM,et al.Diagnosis and management of invasive candidiasis in the ICU: an updated approach to an old enemy[J].Crit Care,2016,20(1):125.DOI: 10.1186/s13054-016-1313-6. [82] PappasPG,KauffmanCA,AndesDR,et al.Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of America[J].Clin Infect Dis,2016,62(4):e1-50.DOI: 10.1093/cid/civ933. [83] WenzelRP.Nosocomial candidemia: risk factors and attributable mortality[J].Clin Infect Dis,1995,20(6):1531-1534.DOI: 10.1093/clinids/20.6.1531. [84] AldejohannAM,Wiese-PosseltM,GastmeierP,et al.Expert recommendations for prevention and management of Candida auris transmission[J].Mycoses,2022,65(6):590-598.DOI: 10.1111/myc.13445. [85] PattersonTF,ThompsonGR3d,Denning DW,et al.Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the infectious diseases society of America[J].Clin Infect Dis,2016,63(4):e1-e60.DOI: 10.1093/cid/ciw326. [86] KusterS,StampfS,GerberB,et al.Incidence and outcome of invasive fungal diseases after allogeneic hematopoietic stem cell transplantation: a Swiss transplant cohort study[J].Transpl Infect Dis,2018,20(6):e12981.DOI: 10.1111/tid.12981. [87] HolzheimerRG,DralleH.Management of mycoses in surgical patients -- review of the literature[J].Eur J Med Res,2002,7(5):200-226. [88] EggimannP,FrancioliP,BilleJ,et al.Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients[J].Crit Care Med,1999,27(6):1066-1072.DOI: 10.1097/00003246-199906000-00019. [89] CornelyOA,MaertensJ,WinstonDJ,et al.Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia[J].N Engl J Med,2007,356(4):348-359.DOI: 10.1056/NEJMoa061094. [90] CornelyOA,BöhmeA,Schmitt-HoffmannA,et al.Safety and pharmacokinetics of isavuconazole as antifungal prophylaxis in acute myeloid leukemia patients with neutropenia: results of a phase 2, dose escalation study[J].Antimicrob Agents Chemother,2015,59(4):2078-2085.DOI: 10.1128/AAC.04569-14. [91] ShenY,HuangXJ,WangJX,et al.Posaconazole vs. fluconazole as invasive fungal infection prophylaxis in China: a multicenter, randomized, open-label study[J].Int J Clin Pharmacol Ther,2013,51(9):738-745.DOI: 10.5414/CP201880. [92] EggimannP,PittetD.Candida colonization index and subsequent infection in critically ill surgical patients: 20 years later[J].Intensive Care Med,2014,40(10):1429-1448.DOI: 10.1007/s00134-014-3355-z. [93] PosteraroB,De PascaleG,TumbarelloM,et al.Early diagnosis of candidemia in intensive care unit patients with sepsis: a prospective comparison of (1→3)-β-D-glucan assay, Candida score, and colonization index[J].Crit Care,2011,15(5):R249.DOI: 10.1186/cc10507. [94] WalshTJ,TepplerH,DonowitzGR,et al.Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia[J].N Engl J Med,2004,351(14):1391-1402.DOI: 10.1056/NEJMoa040446. [95] TimsitJF,AzoulayE,SchwebelC,et al.Empirical micafungin treatment and survival without invasive fungal infection in adults with ICU-acquired sepsis, Candida colonization, and multiple organ failure: the EMPIRICUS randomized clinical trial[J].JAMA,2016,316(15):1555-1564.DOI: 10.1001/jama.2016.14655. [96] SafranDB,DawsonE.The effect of empiric and prophylactic treatment with fluconazole on yeast isolates in a surgical trauma intensive care unit[J].Arch Surg,1997,132(11):1184-1188; discussion 1188-1189.DOI: 10.1001/archsurg.1997.01430350034006. [97] WinstonDJ,HathornJW,SchusterMG,et al.A multicenter, randomized trial of fluconazole versus amphotericin B for empiric antifungal therapy of febrile neutropenic patients with cancer[J].Am J Med,2000,108(4):282-289.DOI: 10.1016/s0002-9343(99)00457-x. [98] WalshTJ,PappasP,WinstonDJ,et al.Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever[J].N Engl J Med,2002,346(4):225-234.DOI: 10.1056/NEJM200201243460403. [99] HassounaH,AthansV,BrizendineKD.Real-world use-Isavuconazole at a large academic medical center[J].Mycoses,2019,62(6):534-541.DOI: 10.1111/myc.12910. [100] KullbergBJ,ViscoliC,PappasPG,et al.Isavuconazole versus caspofungin in the treatment of candidemia and other invasive Candida infections: the ACTIVE trial[J].Clin Infect Dis,2019,68(12):1981-1989.DOI: 10.1093/cid/ciy827. [101] WalshTJ,RaadI,PattersonTF,et al.Treatment of invasive aspergillosis with posaconazole in patients who are refractory to or intolerant of conventional therapy: an externally controlled trial[J].Clin Infect Dis,2007,44(1):2-12.DOI: 10.1086/508774. [102] RodriguezCJ,TribbleDR,MaloneDL,et al.Treatment of suspected invasive fungal infection in war wounds[J].Mil Med,2018,183(Suppl 2):S142-146.DOI: 10.1093/milmed/usy079. [103] Mora-DuarteJ,BettsR,RotsteinC,et al.Comparison of caspofungin and amphotericin B for invasive candidiasis[J].N Engl J Med,2002,347(25):2020-2029.DOI: 10.1056/NEJMoa021585. [104] PappasPG,RotsteinCM,BettsRF,et al.Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis[J].Clin Infect Dis,2007,45(7):883-893.DOI: 10.1086/520980. [105] KettDH,ShorrAF,ReboliAC,et al.Anidulafungin compared with fluconazole in severely ill patients with candidemia and other forms of invasive candidiasis: support for the 2009 IDSA treatment guidelines for candidiasis[J].Crit Care,2011,15(5):R253.DOI: 10.1186/cc10514. [106] KimJH,SuhJW,KimMJ.Evaluation of fluconazole versus echinocandins for treatment of candidemia caused by susceptible common Candida species: a propensity score matching analysis[J].J Fungi (Basel),2023,9(5):539.DOI: 10.3390/jof9050539. [107] ChenD,WanX,KrugerE,et al.Cost-effectiveness of de-escalation from micafungin versus escalation from fluconazole for invasive candidiasis in China[J].J Med Econ,2018,21(3):301-307.DOI: 10.1080/13696998.2017.1417312. [108] XiaoM,FanX,ChenSC,et al.Antifungal susceptibilities of Candida glabrata species complex, Candida krusei, Candida parapsilosis species complex and Candida tropicalis causing invasive candidiasis in China: 3 year national surveillance[J].J Antimicrob Chemother,2015,70(3):802-810.DOI: 10.1093/jac/dku460. [109] ColomboAL,PerfectJ,DiNubileM,et al.Global distribution and outcomes for Candida species causing invasive candidiasis: results from an international randomized double-blind study of caspofungin versus amphotericin B for the treatment of invasive candidiasis[J].Eur J Clin Microbiol Infect Dis,2003,22(8):470-474.DOI: 10.1007/s10096-003-0973-8. [110] HerbrechtR,DenningDW,PattersonTF,et al.Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis[J].N Engl J Med,2002,347(6):408-415.DOI: 10.1056/NEJMoa020191. [111] DouglasAP,SmibertOC,BajelA,et al.Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021[J].Intern Med J,2021,51Suppl 7:S143-176.DOI: 10.1111/imj.15591. [112] OstermannH,SolanoC,JarqueI,et al.Cost analysis of voriconazole versus liposomal amphotericin B for primary therapy of invasive aspergillosis among patients with haematological disorders in Germany and Spain[J].BMC Pharmacol Toxicol,2014,15:52.DOI: 10.1186/2050-6511-15-52. [113] HerbrechtR,PattersonTF,SlavinMA,et al.Application of the 2008 definitions for invasive fungal diseases to the trial comparing voriconazole versus amphotericin B for therapy of invasive aspergillosis: a collaborative study of the Mycoses Study Group (MSG 05) and the European Organization for Research and Treatment of Cancer Infectious Diseases Group[J].Clin Infect Dis,2015,60(5):713-720.DOI: 10.1093/cid/ciu911. [114] MarrKA,SchlammHT,HerbrechtR,et al.Combination antifungal therapy for invasive aspergillosis: a randomized trial[J].Ann Intern Med,2015,162(2):81-89.DOI: 10.7326/M13-2508. [115] CornelyOA,MeemsL,HerbrechtR,et al.Randomised, multicentre trial of micafungin vs. an institutional standard regimen for salvage treatment of invasive aspergillosis[J].Mycoses,2015,58(1):58-64.DOI: 10.1111/myc.12274. [116] CornelyOA,MaertensJ,BresnikM,et al.Liposomal amphotericin B as initial therapy for invasive mold infection: a randomized trial comparing a high-loading dose regimen with standard dosing (AmBiLoad trial)[J].Clin Infect Dis,2007,44(10):1289-1297.DOI: 10.1086/514341. [117] LanternierF,PoireeS,ElieC,et al.Prospective pilot study of high-dose (10 mg/kg/day) liposomal amphotericin B (L-AMB) for the initial treatment of mucormycosis[J].J Antimicrob Chemother,2015,70(11):3116-3123.DOI: 10.1093/jac/dkv236. [118] ShohamS,MagillSS,MerzWG,et al.Primary treatment of zygomycosis with liposomal amphotericin B: analysis of 28 cases[J].Med Mycol,2010,48(3):511-517.DOI: 10.3109/13693780903311944. [119] SkiadaA,PaganoL,GrollA,et al.Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007[J].Clin Microbiol Infect,2011,17(12):1859-1867.DOI: 10.1111/j.1469-0691.2010.03456.x. [120] DonnelleyMA,ZhuES,ThompsonGR3rd.Isavuconazole in the treatment of invasive aspergillosis and mucormycosis infections[J].Infect Drug Resist,2016,9:79-86.DOI: 10.2147/IDR.S81416. [121] Salmanton-GarcíaJ,SeidelD,KoehlerP,et al.Matched-paired analysis of patients treated for invasive mucormycosis: standard treatment versus posaconazole new formulations (MoveOn)[J].J Antimicrob Chemother,2019,74(11):3315-3327.DOI: 10.1093/jac/dkz344. [122] van BurikJA,HareRS,SolomonHF,et al.Posaconazole is effective as salvage therapy in zygomycosis: a retrospective summary of 91 cases[J].Clin Infect Dis,2006,42(7):e61-e65.DOI: 10.1086/500212. [123] GreenbergRN,MullaneK,van BurikJA,et al.Posaconazole as salvage therapy for zygomycosis[J].Antimicrob Agents Chemother,2006,50(1):126-133.DOI: 10.1128/AAC.50.1.126-133.2006. [124] UllmannAJ,SanzMA,TramarinA,et al.Prospective study of amphotericin B formulations in immunocompromised patients in 4 European countries[J].Clin Infect Dis,2006,43(4):e29-38.DOI: 10.1086/505969. [125] WarkentienT,RodriguezC,LloydB,et al.Invasive mold infections following combat-related injuries[J].Clin Infect Dis,2012,55(11):1441-1449.DOI: 10.1093/cid/cis749. [126] GanesanA,ShaikhF,BradleyW,et al.Classification of trauma-associated invasive fungal infections to support wound treatment decisions[J].Emerg Infect Dis,2019,25(9):1639-1647.DOI: 10.3201/eid2509.190168. [127] NeofytosD,OstranderD,ShohamS,et al.Voriconazole therapeutic drug monitoring: results of a prematurely discontinued randomized multicenter trial[J].Transpl Infect Dis,2015,17(6):831-837.DOI: 10.1111/tid.12454. [128] VaesM, HitesM, CottonF, et al. Therapeutic drug monitoring of posaconazole in patients with acute myeloid leukemia or myelodysplastic syndrome[J]. Antimicrob Agents Chemother, 2012, 56(12):6298-6303. DOI: 10.1128/AAC.01177-12. [129] YiWM,SchoepplerKE,JaegerJ,et al.Voriconazole and posaconazole therapeutic drug monitoring: a retrospective study[J].Ann Clin Microbiol Antimicrob,2017,16(1):60.DOI: 10.1186/s12941-017-0235-8. [130] JinH,WangT,FalcioneBA,et al.Trough concentration of voriconazole and its relationship with efficacy and safety: a systematic review and meta-analysis[J].J Antimicrob Chemother,2016,71(7):1772-1785.DOI: 10.1093/jac/dkw045. [131] 凌亚,刘梦颖,李进冬,等.伏立康唑治疗药物监测的治疗成本效果分析[J].徐州医科大学学报,2019,39(5):332-336.DOI: 10.3969/j.issn.2096-3882.2019.05.005. [132] TrifilioS,SinghalS,WilliamsS,et al.Breakthrough fungal infections after allogeneic hematopoietic stem cell transplantation in patients on prophylactic voriconazole[J].Bone Marrow Transplant,2007,40(5):451-456.DOI: 10.1038/sj.bmt.1705754. [133] SavinoJA,AgarwalN,WryP,et al.Routine prophylactic antifungal agents (clotrimazole, ketoconazole, and nystatin) in nontransplant/nonburned critically ill surgical and trauma patients[J].J Trauma,1994,36(1):20-25; discussion 25-26.DOI: 10.1097/00005373-199401000-00004. [134] 付洋,夏照帆.重症烧伤念珠菌病的诊断与治疗[J].中国感染与化疗杂志,2011,11(2):132-134. [135] Jimenez-GarciaL, Celis-AguilarE, Díaz-PavónG, et al. Efficacy of topical clotrimazole vs. topical tolnaftate in the treatment of otomycosis. A randomized controlled clinical trial[J]. Braz J Otorhinolaryngol, 2020,86(3):300-307. DOI: 10.1016/j.bjorl.2018.12.007. [136] WrightJB,LamK,HansenD,et al.Efficacy of topical silver against fungal burn wound pathogens[J].Am J Infect Control,1999,27(4):344-350.DOI: 10.1016/s0196-6553(99)70055-6. [137] PendletonRA,4thHolmes JH.Systemic absorption of amphotericin B with topical 5% mafenide acetate/amphotericin B solution for grafted burn wounds: is it clinically relevant?[J].Burns,2010,36(1):38-41.DOI: 10.1016/j.burns.2009.04.009. [138] KyriopoulosEJ,KyriakopoulosA,KaronidisA,et al.Burn injuries and soft tissue traumas complicated by mucormycosis infection: a report of six cases and review of the literature[J].Ann Burns Fire Disasters,2015,28(4):280-287. [139] ReidG, LynchJP3rd, FishbeinMC, et al. Mucormycosis[J]. Semin Respir Crit Care Med,2020 ,41(1):99-114. DOI: 10.1055/s-0039-3401992. [140] ReischiesF,HoeniglM.The role of surgical debridement in different clinical manifestations of invasive aspergillosis[J].Mycoses,2014,57Suppl 2:1-14.DOI: 10.1111/myc.12224. [141] BalaK,ChanderJ,HandaU,et al.A prospective study of mucormycosis in north India: experience from a tertiary care hospital[J].Med Mycol,2015,53(3):248-257.DOI: 10.1093/mmy/myu086. [142] MitchellTA,HardinMO,MurrayCK,et al.Mucormycosis attributed mortality: a seven-year review of surgical and medical management[J].Burns,2014,40(8):1689-1695.DOI: 10.1016/j.burns.2014.03.013. [143] LittlehalesE,TeagueR,AndrewD,et al.Mucormycosis in burns: a review[J].J Burn Care Res,2022,43(2):353-360.DOI: 10.1093/jbcr/irab236. [144] GavinoC,CotterA,LichtensteinD,et al.CARD9 deficiency and spontaneous central nervous system candidiasis: complete clinical remission with GM-CSF therapy[J].Clin Infect Dis,2014,59(1):81-84.DOI: 10.1093/cid/ciu215. [145] KullbergBJ,van de VeerdonkF,NeteaMG.Immunotherapy: a potential adjunctive treatment for fungal infection[J].Curr Opin Infect Dis,2014,27(6):511-516.DOI: 10.1097/QCO.0000000000000105. [146] DelsingCE,GresnigtMS,LeentjensJ,et al.Interferon-gamma as adjunctive immunotherapy for invasive fungal infections: a case series[J].BMC Infect Dis,2014,14:166.DOI: 10.1186/1471-2334-14-166. [147] BodeyGP,AnaissieE,GuttermanJ,et al.Role of granulocyte-macrophage colony-stimulating factor as adjuvant treatment in neutropenic patients with bacterial and fungal infection[J].Eur J Clin Microbiol Infect Dis,1994,13Suppl 2:S18-22.DOI: 10.1007/BF01973597. -
图 1 《烧伤侵袭性真菌感染诊断与防治实践指南（2024版）》专家推荐意见信息路径图
注：IFI指侵袭性真菌感染《烧伤侵袭性真菌感染诊断与防治实践指南（2024版）》编写组首席专家：罗高兴、袁志强[陆军军医大学（第三军医大学）第一附属医院全军烧伤研究所]专家组成员（单位名称以拼音排序,姓名以姓氏笔画排序）：安徽医科大学第一附属医院烧伤科徐庆连,海军军医大学第一附属医院烧伤外科王光毅、唐洪泰,河北医科大学第三医院烧伤与创面修复中心张庆富,吉林大学第一医院烧伤外科于家傲,暨南大学附属广州红十字会医院烧伤整形科李孝建,江南大学附属医院烧创伤诊疗中心吕国忠,解放军总医院第四医学中心烧伤整形医学部申传安,解放军总医院医学创新研究部转化医学研究中心姚咏明,兰州大学第二医院烧伤整形与创面修复外科刘毅,陆军军医大学（第三军医大学）第一附属医院全军烧伤研究所李海胜、周俊峄、罗高兴、袁志强、彭毅志,陆军军医大学（第三军医大学）第一附属医院药剂科孙凤军,陆军军医大学基础医学院微生物学教研室乐率,南方医科大学第十附属医院烧伤整形外科周军利,南通大学附属医院烧伤整形外科张逸,山东第一医科大学第一附属医院（山东省千佛山医院）烧伤与创面修复外科王一兵,上海交通大学医学院附属瑞金医院灼伤整形科刘琰,深圳大学第一附属医院烧伤整形科吴军、郇京宁,首都医科大学附属北京积水潭医院烧伤科沈余明,首都医科大学附属北京儿童医院烧伤整形科齐鸿燕,武汉大学同仁医院暨武汉市第三医院烧伤科谢卫国,浙江大学医学院附属第二医院烧伤与创面修复科韩春茂,郑州市第一人民医院烧伤科夏成德,《中华烧伤与创面修复杂志》梁光萍,中南大学湘雅医院烧伤整形外科张丕红,中山大学附属第一医院烧伤与创面修复科谢举临
Table 1. 基于GRADE评估体系的推荐强度及证据质量等级描述
项目与类别 描述 推荐强度 强推荐 强烈推荐采用 中等推荐 一般推荐采用 弱推荐 结合临床审慎采用 证据质量等级 高等级 专家组成员非常有信心,未来研究的结果不太可能会改变对效果估计的信心 中等级 专家组成员有适度的信心,效果估计反映了真实的效果,但有可能会改变 低等级 专家组成员的信心有限,效果估计很可能是不确切的,并且未来的研究很可能会改变对效果的理解 极低等级 专家组成员对效果估计几乎没有任何信心 注：GRADE指推荐意见分级的评估、制订和评价 
下载: 导出CSV
Table 2. 烧伤侵袭性真菌感染诊断分级及标准
诊断分级 易感因素 临床特征 实验室检查 血液/无菌组织培养或组织学检查 确诊 ± ± ± 2项中一项为+ 临床诊断 + + + 2项均为- 拟诊 + + - 2项均为- 注：“+”表示符合该项标准,“-”表示不符合该项标准,“±”表示对应的诊断分级与是否符合该项标准无关
下载: 导出CSV
-
图(1) / 表(2)
计量
- 文章访问数: 2287
- HTML全文浏览量: 52
- PDF下载量: 148
- 被引次数: 0
