Invasive Pilzinfektionen

Kernaussagen

• Invasive Pilzinfektionen nehmen bei intensivmedizinisch therapierten Patienten zu.

• Die Sterblichkeit ist trotz neuer antimykotischer Therapieoptionen hoch.

• Besondere Bedeutung hat eine frühzeitige Diagnostik, zumal die Letalität bei verzögertem Therapiebeginn stark ansteigt.

• Zur Therapie der invasiven Candidose sollte man leitlinienkonform Echinocandine als Mittel der Wahl einsetzen.

• Da sich der definitive Erregernachweis oft schwierig gestaltet, sollte man bei kritisch kranken, hämodynamisch instabilen Patienten mit Risikofaktoren für eine invasive Pilzinfektion eine kalkulierte Therapie in Erwägung ziehen.

• Literatur

• 1 Ullmann AJ, Cornely OA, Donnelly JP et al. ESCMID-guideline for the diagnosis and management of Candida diseases 2012: developing European guidelines in clinical microbiology and infectious diseases. Clin Microbiol Infect 2012; 18 (Suppl. 07) 1-8
• 2 Cuenca-Estrella M, Verweij PE, Arendrup MC et al. ESCMID-guideline for the diagnosis and management of Candida diseases 2012: diagnostic procedures. Clin Microbiol Infect 2012; 18 (Suppl. 07) 9-18
• 3 Cornely OA, Bassetti M, Calandra T et al. ESCMID-guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect 2012; 18 (Suppl. 07) 19-37
• 4 Hope WW, Castagnola E, Groll AH et al. ESCMID-guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. Clin Microbiol Infect 2012; 18 (Suppl. 07) 38-52
• 5 Ullmann AJ, Akova M, Herbrecht R et al. ESCMID-guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT). Clin Microbiol Infect 2012; 18 (Suppl. 07) 53-67
• 6 Lortholary O, Petrikkos G, Akova M et al. ESCMID-guideline for the diagnosis and management of Candida diseases 2012: patients with HIV infection or AIDS. Clin Microbiol Infect 2012; 18 (Suppl. 07) 68-77
• 7 Groll AH, Buchheidt D, Cornely O et al. Diagnose und Therapie von Candida-Infektionen. Gemeinsame Empfehlungen der Deutschsprachigen Mykologischen Gesellschaft (DMYKG) und der Paul-Ehrlich-Gesellschaft für Chemotherapie (PEG). Chemotherapie Journal 2011; 20: 67-93
• 8 Pappas PG, Kauffman CA, Andes D et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48: 503-535
• 9 Kriengkauykiat J, Ito JI, Dadwal SS. Epidemiology and treatment approaches in management of invasive fungal infections. Clin Epidemiol 2011; 3: 175-191
• 10 Engel C, Brunkhorst FM, Bone HG et al. Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intensive Care Med 2007; 33: 606-618
• 11 Arendrup MC, Sulim S, Holm A et al. Diagnostic issues, clinical characteristics, and outcomes for patients with fungemia. J Clin Microbiol 2011; 49: 3300-3308
• 12 Kumar A, Ellis P, Arabi Y et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 2009; 136: 1237-1248
• 13 KISS. Krankenhaus-Infektions-Surveillance-System. Referenzdaten. Berechnungszeitraum: Januar 2007 bis Dezember 2011. Im Internet: www.nrz-hygiene.de/surveillance/kiss/its-kiss/infektionen/ Abruf: 05.04.2013
• 14 Geffers C, Gastmeier P. Nosocomial infections and multidrug-resistant organisms in Germany: epidemiological data from KISS (the Hospital Infection Surveillance System). Dtsch Arztebl Int 2011; 108: 87-93
• 15 Pappas PG, Alexander BD, Andes DR et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis 2010; 50: 1101-1111
• 16 Kontoyiannis DP, Marr KA, Park BJ et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis 2010; 50: 1091-1100
• 17 Borg-von Zeppelin M, Kunz L, Rüchel R et al. Epidemiology and antifungal susceptibilities of Candida spp. to six antifungal agents: results from a surveillance study on fungaemia in Germany from July 2004 to August 2005. J Antimicrob Chemother 2007; 60: 424-428
• 18 Tortorano AM, Peman J, Bernhardt H et al. Epidemiology of candidaemia in Europe: results of 28-month European Confederation of Medical Mycology (ECMM) hospital-based surveillance study. Eur J Clin Microbiol Infect Dis 2004; 23: 317-322
• 19 van Burik JA, Magee PT. Aspects of fungal pathogenesis in humans. Annu Rev Microbiol 2001; 55: 743-772
• 20 Lasheras A, Rogues AM, Peyrere S et al. Candida albicans outbreak in a neurosurgical intensive care unit. J Hosp Infect 2007; 65: 181-182
• 21 Rüping MJ, Gerlach S, Fischer G et al. Environmental and clinical epidemiology of Aspergillus terreus: data from a prospective surveillance study. J Hosp Infect 2011; 78: 226-230
• 22 Panackal AA, Imhof A, Hanley EW et al. Aspergillus ustus infections among transplant recipients. Emerging Infect Dis 2006; 12: 403-408
• 23 Heinemann S, Symoens F, Gordts B et al. Environmental investigations and molecular typing of Aspergillus flavus during an outbreak of postoperative infections. J Hosp Infect 2004; 57: 149-155
• 24 Lehrnbecher T, Frank C, Engels K et al. Trends in the postmortem epidemiology of invasive fungal infections at a university hospital. J Infect 2010; 61: 259-265
• 25 Nicolle MC, Bénet T, Thiebaut A et al. Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009. Haematologica 2011; 96: 1685-1691
• 26 Arendrup MC, Fuursted K, Gahrn-Hansen B et al. Semi-national surveillance of fungaemia in Denmark 2004–2006: increasing incidence of fungaemia and numbers of isolates with reduced azole susceptibility. Clin Microbiol Infect 2008; 5: 487-494
• 27 Arendrup MC, Bruun B, Christensen JJ et al. National surveillance of fungemia in Denmark (2004 to 2009). J Clin Microbiol 2011; 49: 325-334
• 28 Pauw B, Walsh TJ, Donnelly JP et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008; 46: 1813-1821
• 29 Avni T, Leibovici L, Paul M. PCR diagnosis of invasive candidiasis: systematic review and meta-analysis. J Clin Microbiol 2011; 49: 665-670
• 30 Mikulska M, Calandra T, Sanguinetti M et al. The use of mannan antigen and anti-mannan antibodies in the diagnosis of invasive candidiasis: recommendations from the Third European Conference on Infections in Leukemia. Crit Care 2010; 14: R222
• 31 Posteraro B, Pascale G, Tumbarello M et al. Early diagnosis of candidemia in intensive care unit patients with sepsis: a prospective comparison of (1–3)-β-D-glucan assay, Candida score, and colonization index. Crit Care 2011; 15: R249
• 32 Koo S, Bryar JM, Page JH et al. Diagnostic performance of the (1–3)-beta-D-glucan assay for invasive fungal disease. Clin. Infect. Dis 2009; 49: 1650-1659
• 33 Arendrup MC, Mavridou E, Mortensen KL et al. Development of azole resistance in Aspergillus fumigatus during azole therapy associated with change in virulence. PLoS ONE 2010; 5: e10080
• 34 Espinel-Ingroff A. Mechanisms of resistance to antifungal agents: yeasts and filamentous fungi. Rev Iberoam Micol 2008; 25: 101-106
• 35 Reboli AC, Rotstein C, Pappas PG et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med 2007; 356: 2472-2482
• 36 Reboli AC, Shorr AF, Rotstein C et al. Anidulafungin compared with fluconazole for treatment of candidemia and other forms of invasive candidiasis caused by Candida albicans: a multivariate analysis of factors associated with improved outcome. BMC Infect Dis 2011; 11: 261
• 37 Bergner R, Hoffmann M, Riedel KD et al. Fluconazole dosing in continuous veno-venous haemofiltration (CVVHF): need for a high daily dose of 800 mg. Nephrol Dial Transplant 2006; 21: 1019-1023
• 38 European Medicines Agency. Assessment Report for Mycamine. London: 2008 Im Internet: www.ema. europa. eu/docs/en_GB/document_library/EPAR_Public_assessment_report/human/000734/WC500031079. pdf Abruf: 05.04.2013
• 39 Ramage G, Rajendran R, Sherry L et al. Fungal biofilm resistance. Int J Microbiol 2012; 2012: 521-528
• 40 Kauffman CA, Vazquez JA, Sobel JD et al. Prospective multicenter surveillance study of funguria in hospitalized patients. The National Institute for Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis 2000; 30: 14-18
• 41 Brunkhorst FM, Gastmeier P, Kern W et al. Prävention und Nachsorge der Sepsis. 1. Revision der S2k-Leitlinien der Deutschen Sepsis-Gesellschaft e. V. (DSG) und der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI). Internist (Berl) 2010; 51: 925-932
• 42 Reinhart K, Brunkhorst FM, Bone HG et al. Prävention, Diagnose, Therapie und Nachsorge der Sepsis. 1. Revision der S-2k Leitlinien der Deutschen Sepsis-Gesellschaft e. V. (DSG) und der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI). Deutsche Sepsis-Gesellschaft e. V.; 2010 Im Internet: www.divi-org.de/fileadmin/pdfs/Leitlinien/Sepsis_Leitlinie_20104. pdf Abruf: 05.04.2013
• 43 León C, Ruiz-Santana S, Saavedra P et al. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med 2006; 34: 730-737
• 44 León C, Ruiz-Santana S, Saavedra P et al. Usefulness of the “Candida score” for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study. Crit Care Med 2009; 37: 1624-1633
• 45 Posteraro B, De Pascale G, Tumbarello M et al. Early diagnosis of candidemia in intensive care unit patients with sepsis: a prospective comparison of (1–3)-beta-D-glucan assay, Candida score, and colonization index. Crit Care 2011; 15: R249
• 46 Pfaller MA, Messer SA, Moet GJ et al. Candida bloodstream infections: comparison of species distribution and resistance to echinocandin and azole antifungal agents in Intensive Care Unit (ICU) and non-ICU settings in the SENTRY Antimicrobial Surveillance Program (2008–2009). Int J Antimicrob Agents 2011; 38: 65-69