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Intensivmedizin up2date 2025; 21(02): 169-185
DOI: 10.1055/a-2372-8973
Allgemeine Intensivmedizin

Pilzinfektionen auf der Intensivstation

Rosanne Sprute‡
,
Jannik Stemler‡
,
Luise Hänsel
,
Florian Pley
,
Albert Wahl
,
Jan-Hendrik Naendrup
,
Oliver A. Cornely
,
Philipp Köhler
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nvasive Mykosen bei intensivmedizinisch betreuten Patient*innen sind komplex: häufig werden sie erst spät erkannt, die Diagnose ist schwierig und die Morbidität und Mortalität sind hoch. Die häufigsten Pilznachweise bei intensivmedizinisch behandelten Patient*innen sind Candida species, Aspergillus species und Pneumocystis jirovecii. Besonders bei kritisch kranken oder immunsupprimierten Patient*innen können invasive Mykosen rasch lebensbedrohlich verlaufen. Eine frühe, gezielte Diagnostik ist entscheidend für Therapie und Prognose.

Kernaussagen

  • Die Anzahl der Patienten mit erhöhtem Risiko für invasive Pilzinfektionen auf der Intensivstation steigt an.

  • Die Klinik ist zumeist unspezifisch; eine weiterführende Diagnostik ist zur Erregersicherung und genaueren Eingrenzung notwendig.

  • Die Candidämie und die abdominelle Candidiasis sind die am häufigsten auf der Intensivstation diagnostizierten Formen der invasiven Candidiasis. Die Umsetzung aktueller Empfehlungen zum Management verbessert das Behandlungsergebnis dieser Erkrankungen.

  • Die pulmonale Aspergillose wird bei prolongiert beatmeten Patient*innen auf der Intensivstation häufig verkannt und ist aufgrund oft fehlender oder maskierter charakteristischer computertomografischer Zeichen schwer zu diagnostizieren. Die Diagnostik beinhaltet Bronchoskopie mit Lavage und Biopsie sowie kulturelle, molekulargenetische und serologische Methoden und ist daher komplex und aufwendig.

  • Die Pneumocystis-Pneumonie betrifft zunehmend auch nicht-HIV-infizierte, kritisch kranke Patient*innen und hat auch in dieser Population eine hohe Sterblichkeit. Bei Patient*innen mit entsprechenden Risikofaktoren, Nachweis passender Infiltrate der Lunge und einem positiven mikrobiologischen Ergebnis sollte unverzüglich eine Therapie eingeleitet werden.

Schlüsselwörter

Candidämie - invasive Candidiasis - Pneumocystis jirovecii - PCP - invasive Aspergillose


Publication History

Article published online:
25 June 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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