ESCMID† and ECMM‡ joint clinical guidelines for the diagnosis and management of mucormycosis 2013

被引：449

作者：

Cornely, O. A. ^{[1
]}

Arikan-Akdagli, S. ^{[2
]}

Dannaoui, E. ^{[3
]}

Groll, A. H. ^{[4
]}

Lagrou, K. ^{[5
]}

Chakrabarti, A. ^{[6
]}

Lanternier, F. ^{[7
,8
]}

Pagano, L. ^{[9
]}

Skiada, A. ^{[10
]}

Akova, M. ^{[2
]}

Arendrup, M. C. ^{[11
]}

Boekhout, T. ^{[12
,13
,14
]}

Chowdhary, A. ^{[15
]}

Cuenca-Estrella, M. ^{[16
]}

Freiberger, T. ^{[17
,18
]}

Guinea, J. ^{[19
]}

Guarro, J. ^{[20
]}

de Hoog, S. ^{[12
]}

Hope, W. ^{[21
]}

Johnson, E. ^{[22
,23
]}

Kathuria, S. ^{[15
]}

Lackner, M. ^{[24
]}

Lass-Floerl, C. ^{[24
]}

Lortholary, O. ^{[7
]}

Meis, J. F. ^{[25
,26
]}

Meletiadis, J. ^{[27
]}

Munoz, P. ^{[19
]}

Richardson, M. ^{[28
,29
]}

Roilides, E. ^{[30
]}

Tortorano, A. M. ^{[31
]}

Ullmann, A. J. ^{[32
]}

van Diepeningen, A. ^{[12
]}

Verweij, P. ^{[26
,33
]}

Petrikkos, G. ^{[34
]}

机构：

[1] Univ Cologne, Cologne Excellence Cluster Cellular Stress Respon, Ctr Integrated Oncol CIO KolnBonn,BMBF 01KN1106, Dept Internal Med 1,Clin Trials Ctr Cologne,ZKS K, D-50937 Cologne, Germany

[2] Hacettepe Univ, Sch Med, Dept Med Microbiol, Ankara, Turkey

[3] Hop Europeen, Lab Microbiol, Unite Parasitol Mycol, Paris, France

[4] Univ Childrens Hosp Munster, Dept Paediat Haematol Oncol, Ctr Bone Marrow Transplantat, Infect Dis Res Programme, Munster, Germany

[5] Katholieke Univ Leuven, Dept Microbiol & Immunol, Clin Dept Lab Med, Louvain, Belgium

[6] Postgrad Inst Med Educ & Res, Dept Med Microbiol, Chandigarh 160012, India

[7] Inst Pasteur, Ctr Natl Reference Mycoses Invas & Antifong, CNRS, Unite Mycol Mol, Paris, France

[8] Univ Paris 05, Hop Necker Enfants Malad, APHP,Ctr Infectiol Necker Pasteur, Serv Malad Infect & Trop,IHU Imagine, Paris, France

[9] Univ Cattolica Sacro Cuore, Dipartimento Ematol, Rome, Italy

[10] Univ Athens, Dept Propaedeut Med 1, Laikon Hosp, Athens 11528, Greece

[11] Statens Serum Inst, Dept Microbiol & Infect Control, Unit Mycol, DK-2300 Copenhagen, Denmark

[12] CBS Fungal Biodivers Ctr CBS KNAW, Utrecht, Netherlands

[13] Univ Med Ctr, Dept Internal Med & Infect Dis, Utrecht, Netherlands

[14] Second Mil Med Univ, Shanghai Key Lab Mol Med Mycol, Inst Dermatol & Med Mycol, Changzheng Hosp, Shanghai, Peoples R China

[15] Univ Delhi, Vallabhbhai Patel Chest Inst, Dept Med Mycol, Delhi 110007, India

[16] Inst Salud Carlos III, Ctr Nacl Microbiol, Madrid, Spain

[17] Masaryk Univ, Ctr Cardiovasc Surg & Transplantat, Mol Genet Lab, Brno, Czech Republic

[18] Masaryk Univ, Cent European Inst Technol CEITEC, Mol Immunol & Microbiol RG, Brno, Czech Republic

[19] Univ Complutense, Hosp Gen Univ Gregorio Maranon, Dept Med Clin Microbiol & Infect Dis, E-28040 Madrid, Spain

[20] Univ Rovira & Virgili, Fac Med, Unitat Microbiol, IISPV, E-43201 Reus, Spain

[21] Univ Liverpool, Dept Mol & Clin Pharmacol, Liverpool L69 3BX, Merseyside, England

[22] PHE Mycol Reference Lab, PHE South West Lab, Bristol, Avon, England

[23] Natl Collect Pathogen Fungi, Bristol, Avon, England

[24] Med Univ Innsbruck, Div Hyg & Med Microbiol, A-6020 Innsbruck, Austria

[25] Canisius Wilhelmina Hosp, Dept Med Microbiol & Infect Dis, Nijmegen, Netherlands

[26] Radboud Univ Nijmegen, Med Ctr, Dept Med Microbiol, NL-6525 ED Nijmegen, Netherlands

[27] Univ Athens, Attikon Univ Gen Hosp, Clin Microbiol Lab, Athens 11528, Greece

[28] Univ S Manchester Hosp, Mycol Reference Ctr, Manchester M20 8LR, Lancs, England

[29] Univ Manchester, Manchester Acad Hlth Sci Ctr, Manchester, Lancs, England

[30] Aristotle Univ Thessaloniki, Sch Med, Hipokrat Hosp, Infect Dis Unit,Dept Paediat 3, GR-54006 Thessaloniki, Greece

[31] Univ Milan, Dept Biomed Sci Hlth, Milan, Italy

[32] Univ Wurzburg, Dept Internal Med 2, D-97070 Wurzburg, Germany

[33] Nijmegen Inst Infect Inflammat & Immun, Nijmegen, Netherlands

[34] Univ Athens, Sch Med, Univ Gen Hosp Attikon, Dept Internal Med 4, Haidari, Greece

来源：

CLINICAL MICROBIOLOGY AND INFECTION | 2014年 / 20卷

基金：

美国国家卫生研究院;

关键词：

Diagnosis; fungal infection; guideline; mucormycosis; mycosis; prophylaxis; treatment; zygomycosis; LIPOSOMAL AMPHOTERICIN-B; IN-VITRO SUSCEPTIBILITIES; ORBITAL-CEREBRAL MUCORMYCOSIS; HEMATOLOGY-ONCOLOGY PATIENTS; ORGAN TRANSPLANT RECIPIENTS; DESORPTION IONIZATION-TIME; INVASIVE FUNGAL-INFECTIONS; MYCOSES STUDY-GROUP; REVERSED HALO SIGN; LIPID COMPLEX;

D O I：

10.1111/1469-0691.12371

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

These European Society for Clinical Microbiology and Infectious Diseases and European Confederation of Medical Mycology Joint Clinical Guidelines focus on the diagnosis and management of mucormycosis. Only a few of the numerous recommendations can be summarized here. To diagnose mucormycosis, direct microscopy preferably using optical brighteners, histopathology and culture are strongly recommended. Pathogen identification to species level by molecular methods and susceptibility testing are strongly recommended to establish epidemiological knowledge. The recommendation for guiding treatment based on MICs is supported only marginally. Imaging is strongly recommended to determine the extent of disease. To differentiate mucormycosis from aspergillosis in haematological malignancy and stem cell transplantation recipients, identification of the reverse halo sign on computed tomography is advised with moderate strength. For adults and children we strongly recommend surgical debridement in addition to immediate first-line antifungal treatment with liposomal or lipid-complex amphotericin B with a minimum dose of 5mg/kg/day. Amphotericin B deoxycholate is better avoided because of severe adverse effects. For salvage treatment we strongly recommend posaconazole 4x200mg/day. Reversal of predisposing conditions is strongly recommended, i.e. using granulocyte colony-stimulating factor in haematological patients with ongoing neutropenia, controlling hyperglycaemia and ketoacidosis in diabetic patients, and limiting glucocorticosteroids to the minimum dose required. We recommend against using deferasirox in haematological patients outside clinical trials, and marginally support a recommendation for deferasirox in diabetic patients. Hyperbaric oxygen is supported with marginal strength only. Finally, we strongly recommend continuing treatment until complete response demonstrated on imaging and permanent reversal of predisposing factors.

引用

页码：5 / 26

页数：22

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