ESCMIDvsIDSA.ppt

* So, how to do in routine clinical practice?Catheters and other indwelling devices should be removed or replaced whenever possible and as early as feasible. An echinocandin or liposomal amphotericin B should be used if a catheter or other device in the blood stream must absolutely be left in place. * 小结“如何做好感染源控制？”：IDSA-尽量拔管，ESCMID-在IDSA的建议下补充：无法拔管的情况下选用LAMB/棘白 * IDSA: recommends drawing blood samples for follow-up blood cultures daily or every other day EFISG: prefers daily sampling the frequency of sampling may be reduced after 5 days, as 80% of patients had negative cultures after this treatment period in the randomised trials. as blood culture negativity is a requirement for treatment discontinuation and ? or step down to oral therapy, it may still be cost-effective to have high-frequency sampling in the whole time period up to the first negative blood culture * IDSA: recommend duration of therapy of two weeks (14 days) after (i) the resolution of symptoms and (ii) the end of candidaemia: first negative blood culture ESCMID: using the time of blood sampling for the first negative blood culture as the starting point for the residual 2 weeks of therapy The criterion of the last positive blood culture is less robust as it depends in the frequency of blood culture sampling * 小结“如何确定抗真菌治疗疗程？”-IDSA与ESCMID一致：血培养转阴后14d * IDSA: switch (‘‘step down’’) patients from an echinocandin to oral fluconazole if they have an initial fungal isolate likely to be susceptible to fluconazole (e.g. C. albicans, C. parapsilosis, C. tropicalis) and if they clinically improved after initial intravenous echinocandin therapy EFISG considers a step down to oral fluconazole feasible after 10 days of intravenous antifungal therapy adequate if the species is susceptible to fluconazole the patient is clinically stable and tolerates oral medication * * 1、2、3文献-阿尼芬净、米卡芬净、卡泊芬净治疗侵袭性念珠菌病的注册临床 It should be noted as a caveat that the evidence base supporting the step-down concept is limited