Introduction

Fungal infection and sensitization are common in chronic respiratory patient populations such as bronchiectasis, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF) and are often associated with prolonged antifungal therapy (Hohmann et al. in Clin Infect Dis 15:939–940, 2010; Vissichelli et al. in Infect Prev Pract 1:100029, 2019), morbidity, and mortality. Although the use of antifungal stewardship (AFS) is increasing within an invasive fungal disease setting, its use and impact within a chronic respiratory setting have not been defined.

Methods

A systematic literature review was conducted using PRISMA guidelines to evaluate the use of antifungal stewardship within a chronic respiratory care setting. Three databases have been searched, Medline via Ovid, Embase and GlobalHealth, for papers published between 1949 and 2020.

Results

The initial search identified 987 papers from Medline, 1761 papers from Embase, and 481 papers from GlobalHealth. Only 28 papers met the criteria for inclusion in this systematic literature review. The included studies were subjected to CASP and GRADE assessments to rank their quality and applicability. Only two studies were focussed on Aspergillus species infection.

Conclusion

Although antifungal stewardship is increasing, its applications are still limited in chronic respiratory care settings despite the prolonged requirement for antifungal therapy and high antimicrobial resistance.

中文翻译：

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呼吸护理机构中的医疗保健利用和抗真菌药物管理的影响：系统文献综述

 介绍

真菌感染和致敏在支气管扩张、慢性阻塞性肺病 (COPD) 和囊性纤维化 (CF) 等慢性呼吸道患者群体中很常见，并且通常与长期抗真菌治疗相关（Hohmann 等人，Clin Infect Dis 15:939– 940，2010；Vissichelli 等人，《感染预防实践》1：100029，2019）、发病率和死亡率。尽管抗真菌药物管理（AFS）在侵袭性真菌病环境中的使用正在增加，但其在慢性呼吸道环境中的使用和影响尚未确定。

 方法

使用 PRISMA 指南进行了系统的文献综述，以评估慢性呼吸护理环境中抗真菌管理的使用。已检索了三个数据库：Medline via Ovid、Embase 和 GlobalHealth，查找 1949 年至 2020 年间发表的论文。

 结果

初步检索发现 Medline 中有 987 篇论文，Embase 中有 1761 篇论文，GlobalHealth 中有 481 篇论文。只有 28 篇论文符合纳入本次系统文献综述的标准。纳入的研究经过 CASP 和 GRADE 评估，以对其质量和适用性进行排名。只有两项研究关注曲霉属物种感染。

 结论

尽管抗真菌药物的管理正在不断增加，但其在慢性呼吸护理环境中的应用仍然受到限制，尽管抗真菌治疗的需要时间较长且抗菌药物耐药性较高。