Revised Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group

Purpose:To describe concisely the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to Candida and Aspergillus infections in non-neutropenic patients in the ICU setting. Methods:A systematic review of the medical literature taking account of national and international guidelines and expert opinion. Results:Severe invasive fungal infections (IFIs) are becoming increasingly frequent in critically ill patients. Approximately 80% of IFIs are due to Candida spp. and 0.3-19% to Aspergillus spp. Recent observations emphasize the necessity of building a worldwide sentinel network to monitor the emergence of new fungal species and changes in susceptibility. Robust data on the attributable mortality are essential for the design of clinical studies with mortality endpoints. Although early antifungal therapy for Candida has been recommended in patients with risk factors, sepsis of unknown cause, and positive Candida serum biomarkers [β-1 → 3-d-glucan (BDG) and Candida albicans germ tube antibody (CAGTA)], its usefulness and influence on outcome need to be confirmed. Future studies may specifically address the optimal diagnostic and therapeutic strategies for patients with abdominal candidiasis. Better knowledge of the pharmacokinetics of antifungal molecules and tissue penetration is a key issue for intensivists. Regarding invasive aspergillosis, further investigation is needed to determine its incidence in the ICU, its relationship with influenza outbreaks, the clinical impact of rapid diagnosis, and the significance of combination treatment. Conclusions:Fundamental questions regarding IFI have to be addressed over the next decade. The clinical studies described in this research agenda should provide a template and set priorities for the clinical investigations that need to be performed.

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“…A common set of definitions allows comparison of results between studies to a certain extent, but even the definitions continue to evolve [3].…”

Section: Introductionmentioning

confidence: 99%

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

et al. 2017

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“…Proven, probable, or possible fungal infection were classified in accordance with criteria from the 2008 version of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) [21]. Proven IFI was defined by one of the following: 1) mold or "black yeast" organism obtained directly from a blood or sterile site culture excluding bronchoalveolar lavage (BAL) fluid, a specimen from a cranial sinus cavity, and urine, or 2) demonstration of hyphae or melanized yeast-like forms by histopathology, cytopathology, or direct microscopy.…”

Section: Definitionsmentioning

confidence: 99%

“…An episode of voriconazole prophylaxis was defined as voriconazole administration to a patient experiencing chemotherapy-induced neutropenia. Patients were considered to have neutropenia when laboratory values indicated an ANC less than 500 cells/ml [4,21]. Neutrophil recovery was defined as an ANC greater than 500 cells/ml for two consecutive days and progressing in an upward direction toward 1000 cells/ml of blood [4,21].…”

Section: Definitionsmentioning

confidence: 99%

“…Data collected regarding voriconazole and IFI clinical outcomes included voriconazole dose, route of administration, frequency, therapeutic drug monitoring (if available), duration of therapy, documented reason for discontinuation, and alternative antifungal therapy if administered. Data for determination of IFI and classification as proven, probable, or possible by EORTC/MSG criteria [21] included sterile site cultures, mycological serologies and radiographic evidence. CT scans were independently reviewed by a radiologist.…”

Section: Data Collectionmentioning

confidence: 99%

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The incidence of invasive fungal infections in neutropenic patients with acute leukemia and myelodysplastic syndromes receiving primary antifungal prophylaxis with voriconazole

et al. 2013

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The objective of this study is to characterize the outcomes of primary antifungal prophylaxis with voriconazole in patients receiving intensive chemotherapy for acute myelogenous leukemia (AML) or myelodysplastic syndromes (MDS). We conducted a single center, retrospective, cohort study of consecutive adult patients with AML or MDS at Mayo Clinic between January 1, 2006 and July 1, 2010. The study included patients undergoing induction or first relapse combination chemotherapy who received voriconazole 200 mg orally twice daily as prophylaxis during the neutropenic phase. Patient records were evaluated until 30 days after neutrophil recovery for development of invasive fungal infection (IFI) as defined per EORTC/MSG 2008 criteria with computed tomography scans independently reviewed by a radiologist. Therapeutic drug monitoring and reasons for voriconazole discontinuation were documented. Twenty four episodes of IFI were detected among 165 consecutive patients for an overall incidence of 145 per 1000 patients. The incidence of IFI was 24, 42, and 78 per 1000 patients for proven, probable, and possible infection, respectively. Four patients developed proven IFI (n = 2 Aspergillus spp., n = 2 Rhizopus spp.). Serum voriconazole trough concentrations were available in 39 patients, and no statistically significant difference in voriconazole trough level was observed between those with versus without an IFI. Voriconazole prophylaxis was discontinued in 81 patients due to suspected IFI (n = 24), fever of unknown origin (n = 19), adverse events (n = 23), and other causes (n = 17). Voriconazole as primary IFI prophylaxis is safe and may be beneficial in AML/MDS patients receiving intensive chemotherapy. Am. J. Hematol. 88:283–288, 2013. © 2013 Wiley Periodicals, Inc.

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“…CT scanning of the chest has a central role in the management of IA, with characteristic findings (nodules with or without a halo, consolidation with cavitation or an air crescent sign) supporting the diagnosis of IFD [10]. However, as the gold standard of a histological diagnosis or culture from sterile material is rarely possible, it becomes immediately obvious that even in a diagnosis-driven strategy combining imaging and galactomannan detection (the only widely used biomarker for IA), treatment is usually given without definitive proof of IA!…”

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confidence: 99%

Pathogen identification by nuclear imaging – almost there?

Agrawal

Mather

2012

Eur J Nucl Med Mol Imaging

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Revised Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group

Abstract: These revised definitions of invasive fungal disease are intended to advance clinical and epidemiological research and may serve as a useful model for defining other infections in high-risk patients.

Cited by 4,448 publications

References 27 publications

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

The incidence of invasive fungal infections in neutropenic patients with acute leukemia and myelodysplastic syndromes receiving primary antifungal prophylaxis with voriconazole

Pathogen identification by nuclear imaging – almost there?

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