title: EPICO 3.0. Management of non-neutropenic patients in medical wards.
abstract: BACKGROUND
  Although the management of invasive fungal infection (IFI) has improved, a number of controversies persist regarding the approach to invasive fungal infection in non-neutropenic medical ward patients.
  
  
  OBJECTIVE
  To identify the essential clinical knowledge to elaborate a set of recommendations with a high level of consensus necessary for the management of IFI in non-neutropenic medical ward patients.
  
  
  METHODS
  A prospective, Spanish questionnaire, which measures consensus through the Delphi technique, was anonymously answered and e-mailed by 30 multidisciplinary national experts, all specialists (intensivists, anesthesiologists, microbiologists, pharmacologists and specialists in infectious diseases) in IFI and belonging to six scientific national societies. They responded to five questions prepared by the coordination group after a thorough review of the literature published in the last few years. For a category to be selected, the level of agreement among the experts in each category had to be equal to or greater than 70%. In a second round, 73 specialists attended a face-to-face meeting held after extracting the recommendations from the chosen topics, and validated the pre-selected recommendations and derived algorithm.
  
  
  RESULTS
  The following recommendations were validated and included in the algorithm: 1. several elements were identified as risk factors for invasive candidiasis (IC) in non-hematologic medical patients; 2. no agreement on the use of the colonization index to decide whether prescribing an early antifungal treatment to stable patients (no shock), with sepsis and no other evident focus and IC risk factors; 3. agreement on the use of the Candida Score to decide whether prescribing early antifungal treatment to stable patients (no shock) with sepsis and no other evident focus and IC risk factors; 4. agreement on initiating early antifungal treatment in stable patients (no shock) with a colonization index>0.4, sepsis with no other evident focus and IC risk factors; 5. agreement on the performance of additional procedures in stable patients (no shock) with sepsis and no other evident focus, IC risk factors, without colonization index>0.4, but with a high degree of suspicion.
  
  
  CONCLUSIONS
  Based on the expert's recommendations, an algorithm for the management of non-neutropenic medical patients was constructed and validated. This algorithm may be useful to support bedside prescription.
authors: Intensive Care Department, Vall d'Hebron University Hospital. Shock, organ dysfunction and Resuscitation Research Group (SODIR), VHIR, Barcelona, Spain. Electronic address: r.ferrer@vhebron.net.
authors: Ricardo
authors: R
authors: Ferrer
authors: Intensive Care Medicine Service, Dr. Peset University Hospital, Valencia, Spain.
authors: Rafael
authors: R
authors: Zaragoza
authors: Intensive Care Unit, Joan XXIII University Hospital, Tarragona, Spain.
authors: Alejandro H
authors: AH
authors: Rodríguez
authors: Anesthesiology Service, La Paz University Hospital, Madrid, Spain.
authors: Emilio
authors: E
authors: Maseda
authors: Infectious Diseases Service, A Coruña University Complex Hospital, A Coruña, Spain.
authors: Pedro
authors: P
authors: Llinares
authors: Pharmacy Service, Hospital del Mar, Barcelona, Spain.
authors: Santiago
authors: S
authors: Grau
authors: Intensive Care Medicine Service, Hospital del Mar, Barcelona, Spain.
authors: Francisco
authors: F
authors: Álvarez-Lerma
authors: Microbiology Service, Faculty of Medicine and Dentistry, Basque Country University, Spain.
authors: Guillermo
authors: G
authors: Quindós
authors: Infectious Diseases Service, Hospital La Fe, Valencia, Spain.
authors: Miguel
authors: M
authors: Salavert
authors: Pharmacy Service, Miguel Servet University Hospital, Zaragoza, Spain.
authors: Rafael
authors: R
authors: Huarte
mesh_terms: D000465:Algorithms; D000935:Antifungal Agents / Q000627:therapeutic use*; D058365:Candidiasis, Invasive / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans
chemical_list: D000935:Antifungal Agents
keywords: Algoritmo de tratamiento; Antifungal treatment; Candidiasis invasiva; Invasive candidiasis; Tratamiento antifúngico; Treatment algorithm