EPICO 2.0 project. Development of educational therapeutic recommendations using the DELPHI technique on invasive candidiasis in critically ill adult patients in special situations

Zaragoza, Rafael; Ferrer, Ricard; Maseda, Emilio; Llinares, Pedro; Rodríguez, Alejandro

doi:10.1016/j.riam.2014.06.001

Cited by 12 publications

(6 citation statements)

References 44 publications

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“…We identified 7230 relevant titles and selected 19 CPGs for inclusion ( Figure 1) (Aguado et al, 2011, Alothman et al, 2014, Bassetti et al, 2013, Bow et al, 2010, Chen et al, 2014, Colombo et al, 2013, Cornely et al, 2012, Elhoufi et al, 2014, JSMM, 2013, Kohno et al, 2016, Kung et al, 2018, Limper et al, 2011, Luo et al, 2014, Montravers et al, 2015, Pappas et al, 2016, Ruhnke et al, 2011, Scudeller et al, 2016, Scudeller et al, 2014, Zaragoza et al, 2014. Table 1 presents the main characteristics of included CPGs.…”

Section: Characteristics Of Selected Guidelinesmentioning

confidence: 99%

“…Two CPGs for IAC recommended antifungal treatment for patients with either secondary nosocomial peritonitis and with risk factors for Candida spp. colonization or patients with tertiary peritonitis (Montravers et al, 2015, Zaragoza et al, 2014. One IFI CPG noted the particular conditions required for initiating antifungal empirical treatment in burn patients (e.g.…”

Section: Guideline Titlementioning

confidence: 99%

“…burn patients who have received two different broad spectrum antibiotics for a minimum of five days) (Luo et al, 2014). With the exception of the ESCMID guideline (Cornely et al, 2012), echinocandins were recommended as the initial drug in all 16 CPGs that supported empirical or pre-emptive treatment (Alothman et al, 2014, Bassetti et al, 2013, Bow et al, 2010, Chen et al, 2014, Colombo et al, 2013, Elhoufi et al, 2014, JSMM, 2013, Kohno et al, 2016, Kung et al, 2018, Luo et al, 2014, Montravers et al, 2015, Pappas et al, 2016, Ruhnke et al, 2011, Scudeller et al, 2016, Scudeller et al, 2014, Zaragoza et al, 2014. Fluconazole and liposomal amphotericin B (L-AMB) were listed as other initial agents in six (Bow et al, 2010, Elhoufi et al, 2014, JSMM, 2013, Kohno et al, 2016, Kung et al, 2018, Montravers et al, 2015 and two (Bassetti et al, 2013, Ruhnke et al, 2011 CPGs, respectively.…”

Section: Guideline Titlementioning

confidence: 99%

“…Five CPGs recommended a duration of two weeks for empirical therapy for suspected IC in patients who improve (Alothman et al, 2014, Bow et al, 2010, Elhoufi et al, 2014, Pappas et al, 2016, Zaragoza et al, 2014. Only two CPGs gave specific details about when to stop empirical antifungal treatment, i.e., in the absence of clinical response to empirical antifungal therapy at 4-5 days and if there is no subsequent evidence of IC after starting empirical therapy or a negative non-culture-based diagnostic assay with a high negative predictive value (Bassetti et al, 2013, Pappas et al, 2016.…”

Section: Guideline Titlementioning

confidence: 99%

“…All 18 candidiasis CPGs recommended echinocandins as the initial drug for Candida spp. (Aguado et al, 2011, Alothman et al, 2014, Bassetti et al, 2013, Bow et al, 2010, Chen et al, 2014, Colombo et al, 2013, Cornely et al, 2012, Elhoufi et al, 2014, JSMM, 2013, Kohno et al, 2016, Kung et al, 2018, Limper et al, 2011, Montravers et al, 2015, Pappas et al, 2016, Ruhnke et al, 2011, Scudeller et al, 2016, Scudeller et al, 2014, Zaragoza et al, 2014 but the burn IFI guideline did not recommend any specific drugs for unidentified Candida spp. Fluconazole, L-AMB, amphotericin B deoxycholate (D-AMB), and voriconazole were mentioned in six (JSMM, 2013, Kohno et al, 2016, Kung et al, 2018, Limper et al, 2011, Montravers et al, 2015, Ruhnke et al, 2011, three (Bassetti et al, 2013, Kohno et al, 2016, Limper et al, 2011, two (Kung et al, 2018, Limper et al, 2011, and one (Limper et al, 2011) CPGs, respectively (Table 4).…”

Section: Targeted Treatment For Icmentioning

confidence: 99%

See 4 more Smart Citations

Antifungal agents for invasive candidiasis in non-neutropenic critically ill adults: What do the guidelines recommend?

Wang

McGuire

Hollingworth

et al. 2019

International Journal of Infectious Diseases

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Objectives: Recommendations in clinical practice guidelines (CPG) may differ and cause confusion. Our objective was to appraise CPGs for antifungal treatment of invasive candidiasis (IC) in non-neutropenic critically ill adult patients. Methods: We systematically searched the literature for CPGs published between 2008 and 2018. We assessed the quality of each guideline using six domains of the AGREE II instrument. We extracted and compared recommendations for different treatment strategies and assessed content quality. Results: Of 19 guidelines, the mean overall AGREE II score was 58%. The domain 'clarity of presentation' received the highest scores (88%) and 'applicability' the lowest (18%). CPGs provided detailed recommendations on antifungal prophylaxis (n = 10), with fluconazole recommended as initial prophylaxis in all seven CPGs citing a specific drug. Echinocandin was recommended as the initial drug in all 16 CPGs supporting empirical/pre-emptive treatment; and in 18 of 19 for targeted invasive candidiasis treatment. However, it remains unclear when to initiate prophylaxis, empirical or preemptive therapy or when to step down. Conclusions: The methodological quality of CPGs for antifungal treatment of IC in non-neutropenic critically ill patients is suboptimal. Some treatment recommendations were inconsistent across indications and require local guidance to help clinicians make better informed decisions.

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