Management of mould pneumonia in resource-limited settings in Asia: A Delphi-based consensus statement by the Asia Fungal Working Group

Abstract

Mould pneumonia can be life-threatening, and its incidence is increasing in Asia. Due to significant variability in diagnostic setups and the availability of antifungal agents, especially in resource-limited settings, the current treatment practices and recommendations for local clinicians are poorly described. This study aimed to develop a consensus statement on the clinical management of mould pneumonia in Asia, particularly within resource-limited settings. Clinicians and infectious disease experts from the Asia Fungal Working Group answered questions about the regional epidemiology as well as diagnostic and resource-limited treatment approaches of mould pneumonia. Guided by a literature review, 22 initial questions were generated and voted upon anonymously using a Delphi-based methodology with predefined consensus criteria. The study comprised two rounds: one to generate summary statements based on the panelists' questionnaire responses, and the other to review, confirm and rate the level of agreement of the consensus statements using a five-point Likert scale. The panelists generated 21 summary statements on the epidemiology (5), diagnosis (8), and treatment (8) of mould pneumonia, 20 of which achieved ≥ 70% consensus. Through a consensus-building exercise, clinical experts from Asia developed a set of 21 consensus statements for the diagnosis and management of mould pneumonia in resource-limited settings.