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Exploring European Consensus About the Remaining Treatment Challenges and Subsequent Opportunities to Improve the
Martin Hoenigl1,2,3, David A Enoch4, Dominic Wichmann5
1Division of Infectious Diseases, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. hoeniglmartin@gmail.com.
Background:
The global prevalence of invasive fungal infections (IFI) is increasing, particularly within Intensive Care Units (ICU), where Candida spp. and Aspergillus spp. represent the most important pathogens. Diagnosis and management of IFIs becomes progressively challenging, with increasing antifungal resistance and the emergence of rare fungal species. Through a consensus survey focused on assessing current views on how IFI should be managed, the aim of this project was to identify challenges around diagnosing and managing IFIs in the ICU. The current status in different countries and perceived challenges to date amongst a multidisciplinary cohort of healthcare professionals involved in the care of IFI in the ICU was assessed.
Methods:
Using a modified Delphi approach, an expert panel developed 44 Likert-scale statements across 6 key domains concerning patient screening and minimal standards for diagnosis of IFIs in ICU; initiation and termination of antifungal treatments and how to minimise their side effects and insights for future research on this topic. These were used to develop an online survey which was distributed on a convenience sampling basis utilising the subscriber list held by an independent provider (M3 Global). This survey was distributed to intensivists, infectious disease specialists, microbiologists and antimicrobial/ICU pharmacists within the UK, Germany, Spain, France and Italy. The threshold for consensus was set at 75%.
Results:
A total of 335 responses were received during the five-month collection period. From these, 29/44 (66%) statements attained very high agreement (≥ 90%), 11/44 (25%) high agreement (< 90% and ≥ 75%), and 4/44 (9%) did not meet threshold for consensus (< 75%).
Conclusion:
The results outline the need for physicians to be aware of the local incidence of IFI and the associated rate of azole resistance in their ICUs. Where high clinical suspicion exists, treatment should start immediately and prior to receiving the results from any diagnostic test. Beta-D-glucan testing should be available to all ICU centres, with results available within 48 h to inform the cessation of empirical antifungal therapy. These consensus statements and proposed measures may guide future areas for further research to optimise the management of IFIs in the ICU.
Insights
Invasive fungal infections (IFIs) are rising in ICUs. Immediate antifungal treatment is recommended for suspected IFIs, with Beta-D-glucan testing to guide therapy cessation.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Medical Microbiology
Background:
- Global incidence of invasive fungal infections (IFIs) is increasing, particularly in Intensive Care Units (ICUs).
- Candida and Aspergillus species are primary pathogens, posing diagnostic and management challenges due to antifungal resistance and emerging fungal species.
- Multidisciplinary healthcare professionals face difficulties in diagnosing and managing IFIs in the ICU setting.
Purpose of the Study:
- To assess current views and identify challenges in diagnosing and managing IFIs in the ICU.
- To evaluate the current status of IFI management across different countries.
- To gather insights from a multidisciplinary cohort on IFI care in ICUs.
Main Methods:
- A modified Delphi approach was used to develop 44 Likert-scale statements on IFI screening, diagnosis, and treatment in ICUs.
- An online survey was distributed to intensivists, infectious disease specialists, microbiologists, and pharmacists in the UK, Germany, Spain, France, and Italy.
- Consensus was defined as 75% agreement on survey statements.
Main Results:
- 335 responses were collected over five months.
- 66% of statements achieved very high agreement (≥90%), and 25% achieved high agreement (≥75%).
- 9% of statements did not meet the consensus threshold (<75%).
Conclusions:
- Physicians must be aware of local IFI incidence and azole resistance rates in ICUs.
- Empirical antifungal treatment should commence immediately upon high clinical suspicion, preceding diagnostic test results.
- Beta-D-glucan testing should be universally available in ICUs, with results within 48 hours to inform antifungal therapy cessation.
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