IDSAIDSA：：20222022新版曲霉菌病诊治指南新版曲霉菌病诊治指南PattersonTF,DenningDW,FishmanJA,etal.PracticeGuidelinesfortheDiagnosisandManagementofAspergillosis:2022UpdatebytheInfectiousDiseasesSocietyofAmerica.[J].Clinicalinfectiousdiseases,2022.PattersonTF,DenningDW,FishmanJA,etal.PracticeGuidelinesfortheDiagnosisandManagementofAspergillosis:2022UpdatebytheInfectiousDiseasesSocietyofAmerica.[J].Clinicalinfectiousdiseases,2022.卢永辉卢永辉2022.07.111微信公众号：感染时间步步非烟微信公众号：感染时间步步非烟第一页，共五十一页。21.EstablishinitiallevelofconfidenceStudydesignInitialconfidenceinanestimateofeffectRandomizedtrialsHighconfidenceObservationalstudiesLowconfidence2.ConsiderloweringorraisinglevelofconfidenceReasonsforconsideringloweringorraisingconfidenceLowerifHigherifRiskofbiasInconsistencyIndirectnessImprecisionPublicationbiasLargeeffectDoseresponseAllplausibleconfounding&bias1.Wouldreduceademonstratedeffector2.Wouldsuggestaspuriouseffectifnoeffectwasobserved3.FinallevelofconfidenceratingConfidenceinanestimateofeffectacrossthoseconsiderationsHighModerateLowVerylow1.RatingtheQualityoftheEvidence第二页，共五十一页。32.DeterminantsoftheStrengthofRecommendationQuality(certainty)ofevidenceResourcesandcostPatients’values&preferencesBalancebetweenBenefits,harms,&burdens第三页，共五十一页。4StrongWeak1.Population:Mostpeopleinthissituationwouldwanttherecommendedcourseofactionandonlyasmallproportionwouldnot2.Healthcareworkers:Mostpeopleshouldreceivetherecommendedcourseofaction3.Policymakers:Therecommendationcanbeadaptedasapolicyinmostsituations1.Population:Themajorityofpeopleinthissituationwouldwanttherecommendedcourseofaction,butmanywouldnot2.Healthcareworkers:Bepreparedtohelppeopletomakeadecisionthatisconsistentwiththeirownvalues/decisionaidsandshareddecisionmaking3.Policymakers:Thereisaneedforsubstantialdebateandinvolvementofstakeholders3.ImplicationoftheStrengthofRecommendation第四页，共五十一页。5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。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2022旧版指南。该2022新版指南于近期发表在ClinicalInfectiousDiseases杂志上。第五页，共五十一页。6?1234567易感者如何预防曲霉菌病？何为易感人群？如何确立侵袭性曲霉菌病的诊断？选用何种抗真菌药治疗及预防侵袭性曲霉菌病？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、治疗适宜人群以及如何处理突破性感染？何时对患者进行经验性治疗？如何处理慢性曲霉菌病、过敏综合征或非侵袭性综合征？第六页，共五十一页。易感者如何易感者如何预防预防曲霉菌病？曲霉菌病？何为易感人群？何为易感人群？117第七页，共五十一页。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，以减少霉菌暴露时机〔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〕。〔3〕假设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，以减少霉菌暴露时机，包括防止园艺、...
