Early Antifungal Treatment in Immunocompromised Patients, Including Hematological and Critically Ill Patients

TL;DR

This paper provides expert consensus on early antifungal treatment for immunocompromised patients to improve outcomes in invasive fungal diseases.

Contribution

A multidisciplinary panel developed evidence-based guidelines for timely empiric antifungal therapy in high-risk patients.

Findings

Early targeted antifungal therapy is recommended for high-risk patients with suspected IFDs.

Empiric therapy can be initiated before diagnosis, based on local fungal prevalence and patient risk.

Switching antifungal classes may be needed for patients with deterioration or side effects.

Abstract

(1) Background: Invasive fungal diseases (IFDs) represent significant challenges in clinical practice, particularly among immunocompromised individuals, leading to substantial morbidity and mortality. The present document aims to provide evidence-based consensus for the timely initiation of antifungal treatment, focusing on early empiric approaches among immunocompromised patients. (2) Methods: A multidisciplinary expert panel of nine healthcare professionals (HCPs) reviewed the literature, including guidelines and consensus reports (2013–2023; PubMed, Scopus). The panel defined appropriate empiric antifungal approaches for invasive candidiasis, aspergillosis, and mucormycosis among hematological and critically ill patients. Consensus was defined as ≥75% agreement. (3) Results: A total of 47 statements were included. The experts recommend that early targeted antifungal therapy is critical for high-risk patients with suspected IFDs. Empiric therapy may be initiated before definitive diagnosis, considering the local fungal prevalence and the patient’s risk category. Close monitoring is essential, and switching between antifungal classes may be necessary for patients who experience deterioration or side effects. The transition from intravenous to oral therapy depends on the specific infection, the availability of therapeutic drug monitoring, and the patient’s progress. (4) Conclusions: Implementing this targeted, early approach may improve the outcomes of vulnerable patients with IFDs.

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