Invasive aspergillosis (IA) is an acute infection affecting patients who are immunocompromised, as a result of receiving chemotherapy for malignancy, or immunosuppressant agents for transplantation or autoimmune disease. Whilst criteria exist to define the probability of infection for clinical trials, there is little evidence in the literature or clinical guidelines on when to change antifungal treatment in patients who are receiving prophylaxis or treatment for IA. To try and address this significant gap, an advisory board of experts was convened to develop criteria for the management of IA for use in designing clinical trials, which could also be used in clinical practice. For primary treatment failure, a change in antifungal therapy should be made: (i) when mycological susceptibility testing identifies an organism from a confirmed site of infection, which is resistant to the antifungal given for primary therapy, or a resistance mutation is identified by molecular testing; (ii) at, or after, 8 days of primary antifungal treatment if there is increasing serum galactomannan, or galactomannan positivity in serum, or bronchoalveolar lavage fluid when the antigen was previously undetectable, or there is sudden clinical deterioration, or a new clearly distinct site of infection is detected; and (iii) at, or after, 15 days of primary antifungal treatment if the patient is clinically stable but with ≥2 serum galactomannan measurements persistently elevated compared with baseline or increasing, or if the original lesions on CT or other imaging, show progression by >25% in size in the context of no apparent change in immune status.

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何时改变急性侵袭性曲霉病的治疗：专家观点

侵袭性曲霉病 (IA) 是一种急性感染，影响免疫功能低下的患者，这是由于接受恶性肿瘤化疗或移植免疫抑制剂或自身免疫性疾病的结果。虽然存在定义临床试验感染概率的标准，但文献或临床指南中几乎没有证据表明何时在接受 IA 预防或治疗的患者中改变抗真菌治疗。为了试图解决这一重大差距，召集了一个专家咨询委员会来制定用于设计临床试验的 IA 管理标准，该标准也可用于临床实践。对于主要治疗失败，应改变抗真菌治疗：(i) 当真菌学药敏试验从已确认的感染部位鉴定出一种生物体，该生物体对用于主要治疗的抗真菌剂具有抗性，或通过分子检测鉴定出耐药性突变时；(ii) 在初次抗真菌治疗 8 天或之后，如果血清半乳甘露聚糖或血清中半乳甘露聚糖阳性，或以前无法检测到抗原时支气管肺泡灌洗液，或出现突然的临床恶化，或新的明显不同的检测到感染部位；(iii) 在初次抗真菌治疗 15 天或之后，如果患者临床稳定但血清半乳甘露聚糖测量值与基线相比持续升高或增加，或者如果 CT 或其他成像上的原始病变显示进展>