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• W2887187411 abstract "espanolObjetivos. Elaborar unas recomendaciones practicas basadas en la evidencia cientifica, cuando este disponible, o en opiniones de expertos para el diagnostico, tratamiento y prevencion de infecciones fungicas respiratorias en el paciente critico incluyendo a pacientes trasplantados de organo solido. Metodos. Doce expertos pertenecientes a dos Sociedades Cientificas (Sociedad Espanola de Quimioterapia y Sociedad Espanola de Medicina Intensiva, Critica y Unidades Coronarias) revisaron en una reunion celebrada en Marzo de 2012 los aspectos epidemiologicos y factores de riesgo como base para generar un documento para la prevencion, diagnostico y tratamiento de infecciones fungicas respiratorias causadas por Candida spp., Aspergillus spp. o Zigomicetos. Resultados. A pesar del frecuente aislamiento de Candida spp. del tracto respiratorio, el tratamiento antifungico no estarecomendado debido a que una neumonia por estas especies es excepcional en pacientes no neutropenicos. En el caso de Aspergillus spp., aproximadamente el 50% de los aislamientos en UCI indican colonizacion y el otro 50% de los casos estan asociados a aspergilosis pulmonar invasora (API), una infeccion con una alta mortalidad. Los principales factores de riesgo de una infeccion fungica invasora en la UCI son el tratamiento previo con esteroides y enfermedad pulmonar obstructiva cronica (EPOC). La recogida de muestras mediante lavado broncoalveolar esta recomendada para el cultivo y la determina cion de galactomanano. Voriconazol y anfotericina liposomal B presentan la indicacion como tratamiento de primera linea mientras que caspofungina esta indicada en la terapia de rescate. Aunque no hay datos solidos que apoyen la evidencia cientifica, el grupo de expertos recomiendan la terapia combinada en el paciente critico con sepsis o fallo respiratorio severo. Los zigomicetos causan infeccion respiratoria principalmente en pacientes neutropenicos, y anfotericina liposomal B es la terapia de eleccion. Conclusiones. La presencia de hongos en muestras respiratorias de pacientes criticos conlleva diferentes enfoques de diagnostico y manejo clinico. API es la infeccion mas frecuente y presenta una alta mortalidad. EnglishObjective. To elaborate practical recommendations based on scientific evidence, when available, or on expert opinions for the diagnosis, treatment and prevention of fungal respiratory infections in the critically ill patient, including solid organ transplant recipients. Methods. Twelve experts from two scientific societies (The Spanish Society for Chemotherapy and The Spanish Society of Intensive Care and Coronary Units) reviewed in a meeting held in March 2012 epidemiological issues and risk factors as basis for a document about prevention, diagnosis and treatment of respiratory fungal infections caused by Candida spp., Aspergillus spp or Zygomycetes. Results. Despite the frequent isolation of Candida spp. from respiratory tract samples, antifungal treatment is not recommended since pneumonia by this fungal species is exceptional in non-neutropenic patients. In the case of Aspergillus spp., approximately 50% isolates from the ICU represent colonization, and the remaining 50% cases are linked to invasive pulmonary aspergillosis (IPA), an infection of high mortality. Main risk factors for invasive disease in the ICU are previous treatment with steroids and chronic obstructive pulmonary disease (COPD). Collection of BAL sample is recommended for culture and galactomannan determination. Voriconazole and liposomal amphotericin B have the indication as primary therapy while caspofungin has the indication as salvage therapy. Although there is no solid data supporting scientific evidence, the group of experts recommends combination therapy in the critically ill patient with sepsis or severe respiratory failure. Zygomycetes cause respiratory infection mainly in neutropenic patients, and liposomal amphotericin B is the elective therapy. Conclusions. Presence of fungi in respiratory samples from critically ill patients drives to different diagnostic and clinical management approaches. IPA is the most frequent infection and with high mortality." @default.
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• W2887187411 date "2013-01-01" @default.
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• W2887187411 title "Epidemiología, diagnóstico y tratamiento de las infecciones fúngicas respiratorias en el paciente crítico" @default.
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