IDSA2016新版曲霉菌病诊治指南
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3. Policy makers: There is a need for substantial debate and involvement of stakeholders
4
曲霉菌病是感染曲霉菌引起的一种真菌病，可累及皮肤、 黏膜、眼、鼻、支气管、肺、胃肠道、神经系统、骨骼等多 器官系统，严重者导致败血症，病例呈世界性分布。病原体 曲霉菌属丝状真菌，是一种常见的条件致病性真菌，广泛分 布于自然界，其感染者并不少见。
2. Healthcare workers: Most people should receive the recommended course of action
3. Policy makers: The recommendation can be adapted as a policy in most situations
2 如何确立侵袭性曲霉菌病的诊断？ 3 选用何种抗真菌药治疗及预防侵袭性曲霉菌病？ 4 侵袭性曲霉菌病推荐治疗方案和辅助治疗方法都有哪些？
有哪些预防性治疗推荐方案、治疗适宜人群以及 5 如何处理突破性感染？ 6 何时对患者进行经验性治疗？
7 如何处理慢性曲霉菌病、过敏综合征或非侵袭性综合征？
? 6
1
2. Would suggest a spurious effect if no effect was observed
3. Final level of confidence rating
Confidence in an estimate of effect across those considerations
Resources and cost
3
3. Implication of the Strength of Recommendation
Strong 1. Population: Most people in this
situation would want the recommended course of action and only a small proportion would not
（3）若住院无法提供防护病房的条件，推荐此类患者入住单独病房，且病 房远离施工场地，也不允许将绿植或鲜花带入病房（强烈推荐；证据级别 低）。
（4）建议对 IA 高危门诊患者采取合理防护措施，以减少霉菌暴露机会， 包括避免园艺、施肥劳作或密切接触装修或施工场地（强烈推荐；证据级 别低）。
IDSA：2016 新版曲霉菌病诊治指南
卢永辉
2016.07.11
微信公众号：感染时间 步步非烟
Patterson TF, Denning DW, Fishman JA, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America.[J]. Clinical infectious diseases, 2016.
High confidence
Observational Low
studies
confidence
2. Consider lowering or raising level of confidence
Reasons for considering lowering or raising confidence
时隔 8 年，美国感染病学会（IDSA）就曲霉菌病临床 关注的热点问题，总结现有不同类型曲霉菌病相关证据，于 近期发布了新版曲霉菌病诊治指南，替代 2008 旧版指南。 该 2016 新版指南于近期发表在 Clinical Infectious Diseases 杂志上。
5
Βιβλιοθήκη Baidu
1 易感者如何预防曲霉菌病？何为易感人群？
High
Moderate
Low
Very low
2
2. Determinants of the Strength of Recommendation
Quality (certainty) of evidence
Balance between Benefits, harms, &burdens
Patients’ values & preferences
Lower if
Higher if
Risk of bias Inconsistency Indirectness Imprecision Publication bias
Large effect
Dose response
All plausible confounding & bias
1. Would reduce a demonstrated effect or
Weak
1. Population: The majority of people in this situation would want the recommended course of action, but many would not
2. Healthcare workers: Be prepared to help people to make a decision that is consistent with their own values/decision aids and shared decision making
易感者如何预防曲霉菌病？ 何为易感人群？
7
一 流行病学与感染风险因素
（1）应将住院的异体造血干细胞移植（HSCT）接受者安置在受保护的环境 中，以减少霉菌暴露机会（强烈推荐；证据级别低）。
（2）也应给予其他严重免疫功能低下的、易发生侵袭性曲霉菌病（IA）的 高危患者相应防护措施，如急性白血病正在接受诱导/再诱导化疗方案治疗 者（强烈推荐；证据级别低）。
1
1. Rating the Quality of the Evidence
1. Establish initial level of confidence
Study design
Randomized trials
Initial confidence in an estimate of effect
4
曲霉菌病是感染曲霉菌引起的一种真菌病，可累及皮肤、 黏膜、眼、鼻、支气管、肺、胃肠道、神经系统、骨骼等多 器官系统，严重者导致败血症，病例呈世界性分布。病原体 曲霉菌属丝状真菌，是一种常见的条件致病性真菌，广泛分 布于自然界，其感染者并不少见。
2. Healthcare workers: Most people should receive the recommended course of action
3. Policy makers: The recommendation can be adapted as a policy in most situations
2 如何确立侵袭性曲霉菌病的诊断？ 3 选用何种抗真菌药治疗及预防侵袭性曲霉菌病？ 4 侵袭性曲霉菌病推荐治疗方案和辅助治疗方法都有哪些？
有哪些预防性治疗推荐方案、治疗适宜人群以及 5 如何处理突破性感染？ 6 何时对患者进行经验性治疗？
7 如何处理慢性曲霉菌病、过敏综合征或非侵袭性综合征？
? 6
1
2. Would suggest a spurious effect if no effect was observed
3. Final level of confidence rating
Confidence in an estimate of effect across those considerations
Resources and cost
3
3. Implication of the Strength of Recommendation
Strong 1. Population: Most people in this
situation would want the recommended course of action and only a small proportion would not
（3）若住院无法提供防护病房的条件，推荐此类患者入住单独病房，且病 房远离施工场地，也不允许将绿植或鲜花带入病房（强烈推荐；证据级别 低）。
（4）建议对 IA 高危门诊患者采取合理防护措施，以减少霉菌暴露机会， 包括避免园艺、施肥劳作或密切接触装修或施工场地（强烈推荐；证据级 别低）。
IDSA：2016 新版曲霉菌病诊治指南
卢永辉
2016.07.11
微信公众号：感染时间 步步非烟
Patterson TF, Denning DW, Fishman JA, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America.[J]. Clinical infectious diseases, 2016.
High confidence
Observational Low
studies
confidence
2. Consider lowering or raising level of confidence
Reasons for considering lowering or raising confidence
时隔 8 年，美国感染病学会（IDSA）就曲霉菌病临床 关注的热点问题，总结现有不同类型曲霉菌病相关证据，于 近期发布了新版曲霉菌病诊治指南，替代 2008 旧版指南。 该 2016 新版指南于近期发表在 Clinical Infectious Diseases 杂志上。
5
Βιβλιοθήκη Baidu
1 易感者如何预防曲霉菌病？何为易感人群？
High
Moderate
Low
Very low
2
2. Determinants of the Strength of Recommendation
Quality (certainty) of evidence
Balance between Benefits, harms, &burdens
Patients’ values & preferences
Lower if
Higher if
Risk of bias Inconsistency Indirectness Imprecision Publication bias
Large effect
Dose response
All plausible confounding & bias
1. Would reduce a demonstrated effect or
Weak
1. Population: The majority of people in this situation would want the recommended course of action, but many would not
2. Healthcare workers: Be prepared to help people to make a decision that is consistent with their own values/decision aids and shared decision making
易感者如何预防曲霉菌病？ 何为易感人群？
7
一 流行病学与感染风险因素
（1）应将住院的异体造血干细胞移植（HSCT）接受者安置在受保护的环境 中，以减少霉菌暴露机会（强烈推荐；证据级别低）。
（2）也应给予其他严重免疫功能低下的、易发生侵袭性曲霉菌病（IA）的 高危患者相应防护措施，如急性白血病正在接受诱导/再诱导化疗方案治疗 者（强烈推荐；证据级别低）。
1
1. Rating the Quality of the Evidence
1. Establish initial level of confidence
Study design
Randomized trials
Initial confidence in an estimate of effect