Validité des prescriptions d’antifongiques large spectre pour candidose invasive en réanimation, à la lumière des principales recommandations internationales

Abstract : Purpose: the main objective was to describe the Class III antifungal therapy prescription’s validity in the indication of invasive candidiasis at the light of the main international guidelines. The secondary objective was to compare these guidelines in term of clarity and clinical application in the treatment of invasive candidiasis. Method: monocentric, retrospective, observationnal study, all the patient who receive a class III antifungal therapy were included. Each case was presented at an expert committee who judged with the DELPHI method, in a 3 rounds system if the prescription was either in agreement or not in agreement with the 4 choosen guidelines (IDSA 2016, ESCMID 2012, ATS 2010 et SFAR/SRLF 2004) or last possibility if the guideline was not applicable to the case. Results: 55 antifungal prescriptions were analysed, 42 targeted the candida spp. When the guidelines were applicable, the rate of prescriptions in agreement with the guidelines was 86% for the IDSA, 87% for the ESCMID, 90% for the ATS and 23% for the SFAR/SRLF. The rate of prescriptions judged applicable at the first round of the DELPHI method was 81% for the IDSA, 59% for the ESCMID, 62% for the SFAR/SRLF and 17% for the ATS Conclusion: when the guidelines were applicable the prescriptions were mainly in agreement with the most recent ones. IDSA 2016 answered easily to the largest situations.
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Master Thesis
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Gaspard Cadier. Validité des prescriptions d’antifongiques large spectre pour candidose invasive en réanimation, à la lumière des principales recommandations internationales. Médecine humaine et pathologie. 2017. ⟨dumas-01546064⟩

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