A Spanish prospective questionnaire, which measures consensus through the Delphi technique, was anonymously answered and e-mailed by 30 multidisciplinary national experts, all specialists in fungal invasive
infections from six scientific national societies; intensivists, anesthesiologists, microbiologists, pharmacologists and specialists in
infectious diseases. They responded to 10 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 must 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: Assess administering antifungal treatment to patients with high/medium risk factors and
fever for over 4 days after onset of
antibiotic therapy, and in the event of negative
galactomannan or if no detection analysis has been performed and no relevant findings in the sinus and chest computed tomography (CT) have been detected, (1) in the case the patient did not receive prophylaxis, or was administered
fluconazole,
caspofungin treatment is recommended; (2) in the event the patient received prophylaxis with an
azole with activity against filamentous fungi, the administration of
liposomal amphotericin B is recommended and
caspofungin as second choice
therapy; (3) in the event that the prophylaxis received was an
echinocandin,
liposomal amphotericin B therapy is recommended and
voriconazole as second choice. Assess administering antifungal treatment in patients with high/medium risk factors and
fever for more than 4 days after onset of
antibiotic therapy, and in the event of a positive
galactomannan and/or sinus and chest CT suggests
fungal infection caused by filamentous fungi, (1) in the event the patient did not receive antifungal prophylaxis or was administered
fluconazole, the recommended treatment of choice is
voriconazole or
liposomal amphotericin B; (2) if the patient received prophylaxis with an
azole with activity against filamentous fungi, the administration of
liposomal amphotericin B with
caspofungin is recommended and monotherapy with
liposomal amphotericin B or the combination of
voriconazole and
anidulafungin are recommended as second choice
therapies; (3) in the event an
echinocandin was administered as prophylaxis,
liposomal amphotericin B or
voriconazole are the recommended treatments of choice. Consider the administration of antifungal treatment in patients with high/medium risk factors and
fever for more than 4 days after onset of
antibiotic therapy, and in the event of a negative
galactomannan and the sinus and chest CT suggests
fungal infection caused by filamentous fungi, (1) if the patient did not receive prophylaxis or was administered
fluconazole, the recommended treatment of choice is
liposomal amphotericin B or
voriconazole; (2) in the case the patient received prophylaxis with an
azole with activity against filamentous fungi, the administration of
liposomal amphotericin B is recommended as first choice
therapy and
liposomal amphotericin B combined with
caspofungin as second choice; (3) in the event an
echinocandin was administered as prophylaxis,
liposomal amphotericin B or
voriconazole are the recommended treatments of choice.
CONCLUSIONS: