Diagnostic and therapeutic approach to fungal pneumonia in the critically ill patient

ABSTRACT

Aspergillus spp. is the fungus most frequently producingventilator-associated pneumonia (VAP), constituting 8% ofthem. This risk is significantly increased in onco-hematologicalpatients solid organ transplant recipients, chronic obstructivepulmonary disease (COPD), corticotherapy, cirrhosis, solid cancer, or viral pneumonias. The European Organization for Research and Treatment of Cancer Mycoses (EORT/MSG criteria)developed for onco-hematological patients with angioinvasiveforms of aspergillosis have important limitations for broncho-pulmonary forms, such as aspergillosis cases in the ICU. Inrecent years, new diagnostic criteria were developed to have agreater role in broncho-alveolar lavage, especially GM and lateral flow assay (LFA). Voriconazole and isavuconazole are thefirst treatment option. However, drug-drug interaction, levelrequirements, toxicity, and QT-interval modification are limitations that may favor isavuconazole or liposomal amphotercinB in the ICU. (AU)