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Eur J Intern Med. 2016 Oct;34:45-53. doi: 10.1016/j.ejim.2016.07.007. Epub 2016 Aug 3.

MEDical wards Invasive Candidiasis ALgorithms (MEDICAL):Consensus proposal for management.

Author information

1
Clinical Epidemiology Unit, Scientific Direction, IRCCS, Policlinico San Matteo Foundation, Pavia, Italy. Electronic address: l.scudeller@smatteo.pv.it.
2
Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy.
3
Section of Infectious Diseases, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Policlinico G B Rossi, Verona, Italy.
4
Department of Internal Medicine, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Di.Bi.M.I.S., University of Palermo, Italy.
5
Infectious Diseases Unit, Teaching Hospital Policlinico S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy.
6
Department of Medical Sciences, University of Torino, Torino, Italy.
7
Clinic of Infectious Diseases, IRCCS San Martino-IST, University of Genova, Genova, Italy.
8
Internal Medicine Section, Department of Cardiothoracic Sciences, and Division of Infectious and Transplant Medicine, Second University of Naples at Monaldi Hospital, Napoli, Italy.
9
Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
10
Infectious Disease Department, Cisanello Hospital, Pisa, Italy.
11
Infectious Diseases Institute, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
12
Internal Medicine Department, Hospital of Legnano, Legnano, Italy.

Abstract

INTRODUCTION:

A majority of invasive Candida infections occur in medical wards; however, evidence for management in this setting is scarce and based primarily on the intensive care or surgical setting. On behalf of the Italian Society for Anti-Infective Therapy (SITA) and the Italian Federation of Associations of Hospital Doctors on Internal Medicine (FADOI), the MEDICAL group produced practical management algorithms for patients in internal medicine wards.

METHODS:

The MEDICAL group panel, composed of 30 members from internal medicine, infectious disease, clinical pharmacology, clinical microbiology and clinical epidemiology, provided expert opinion through the RAND/UCLA method.

RESULTS:

Seven clinical scenarios were constructed based on clinical severity and probability of invasive candidiasis. For each scenario, the appropriateness of 63 different diagnostic, imaging, management, or therapeutic procedures was determined in two Delphi rounds. The necessity for performing each appropriate procedure, was then determined in a third Delphi round. Results were summarized in algorithms.

DISCUSSION:

The proposed algorithms provide internal medicine physicians and managers with an easy to interpret tool that is exhaustive, clear and suitable for adaption to individual local settings. Attention was paid to individual patient management and resource allocation.

KEYWORDS:

Clinical severity; Invasive candidiasis; Medical wards; Risk stratification

PMID:
27495949
DOI:
10.1016/j.ejim.2016.07.007
[Indexed for MEDLINE]
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