Girmenia, C., Barosi, G., Piciocchi, A., Arcese, W., Aversa, F., Bacigalupo, A., . . . Rambaldi, A. (2014). Primary prophylaxis of invasive fungal diseases in allogeneic stem cell transplantation: Revised recommendations from a consensus process by Gruppo Italiano Trapianto Midollo Osseo (GITMO). Biology of Blood and Marrow Transplantation, 20, 1080–1088. 

DOI Link

Purpose & Patient Population

PURPOSE: To update guidelines designed to improve awareness, diagnosis, and management of invasive fungal infection (IFI) among transplantation patients and to better define prophylactic and therapeutic options for clinical practice
 
TYPES OF PATIENTS ADDRESSED: Adults and children undergoing allogeneic stem cell transplantation

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Evidence-based guideline  
 
PROCESS OF DEVELOPMENT: A systematic review of literature was done and reviewed by an advisory committee and panel of experts, who drafted statements and recommendations. These were reviewed by all panel members and rated as to agreement. Final recommendations and statements were determined by consensus.
 
DATABASES USED: PubMed
 
KEYWORDS: Fungal infections, epidemiology, allogeneic stem cell transplantation, antifungal prophylaxis
 
INCLUSION CRITERIA: Large single-center or multicenter series. Allogeneic transplantation cases only

Phase of Care and Clinical Applications

PHASE OF CARE: Transition phase after treatment

Results Provided in the Reference

Volume of articles retrieved is not reported. Provides a three-level strength of recommendation and three-level grading of evidence quality. Ten studies are summarized.

Guidelines & Recommendations

The studies defined risk factors for patients to be considered high risk in early, late, and very late phases post-transplantation. It is recommended that high-risk patients receive mold-active prophylaxis and all remaining patients receive Candida-active prophylaxis in the early and late phases. In the very late phase, it is recommended that those at high risk, based on severity and steroid refractory graft-versus-host disease, receive mold-active prophylaxis; those with a standard risk receive Candida-active prophylaxis; and those at low risk receive no prophylaxis. The studies provide an extensive definition of risk levels for use.

Limitations

  • There is limited evidence in children.
  • All the evidence used was retrospective.

Nursing Implications

Studies provide information to determine level of risk in various transplantation phases and gives guidance regarding antifungal prophylaxis in each phase. Nurses need to be aware of changing risk in various transplantation phases of care.