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Update: invasive Pilzinfektionen

Diagnose und Therapie in der operativen Intensivmedizin

Update: invasive fungal infections

Diagnosis and treatment in surgical intensive care medicine

  • Intensivmedizin
  • Published:
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Zusammenfassung

Pilzinfektionen sind in der operativen Intensivmedizin nicht selten. Candida-Spezies bilden dabei den Großteil der pilzlichen Erreger. Insbesondere bei Patienten mit vorbestehenden Lungenerkrankungen ist auch auf die Entstehung einer pulmonalen Aspergillose zu achten. Der frühzeitige Beginn der adäquaten antimykotischen Therapie ist entscheidend für den Erfolg. Hierzu ist eine Risikoabschätzung notwendig, die anhand von individuellen Patientenmerkmalen den Zeitpunkt des Behandlungsbeginns festlegt. Im Fall einer Candida-Infektion des klinisch stabilen Intensivpatienten ohne Organdysfunktion, der im Vorfeld kein Azol erhielt, bleibt Fluconazol das Mittel der Wahl, sofern die lokalen epidemiologischen Bedingungen nicht dagegen sprechen. Für instabile Intensivpatienten mit Organdysfunktionen stellen die Echinocandine aufgrund ihres breiten Wirkspektrums und ihrer guten Verträglichkeit die erste Wahl dar. Empfindlichkeitstestungen werden aufgrund des relevanten Anteils azolresistenter Candida-Spezies empfohlen. Abhängig vom nachgewiesenen Erreger ist das Umsetzen der Therapie auf ein Azol nach klinischer Stabilisierung möglich. Eine Aspergillose wird primär mit Voriconazol behandelt.

Abstract

Fungal infections are of great relevance in surgical intensive care and Candida species represent the predominant part of fungal pathogens. Invasive aspergillosis is also relevant especially in patients with chronic pulmonary diseases. It is crucial for therapy success to begin adequate antifungal treatment at an early stage of the disease. Risk stratification of individual patient symptoms is essential for therapy timing. In case of suspected or proven candida infection, fluconazole is the agent of choice when the patient is clinically stable and no azoles have been administrated in advance and the local epidemiology makes azol resistance unlikely. For clinically instable patients with organ dysfunction the echinocandins serve as primary therapy because of their broad spectrum and reasonable safety profile. Due to a relevant proportion of azole resistant Candida species, susceptibility testing should be done routinely. Depending on the species detected de-escalating to an azole is feasible if organ dysfunctions have resolved. An invasive aspergillosis is primarily treated with voriconazole.

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Der korrespondierende Autor weist auf folgende Beziehungen hin:

C. Lichtenstern erhielt Reisekostenunterstützung von Pfizer, Wyeth und Schering-Plough/Essex; er ist beratend tätig für Merck/MSD.

T. Hoppe-Tichy hielt Vorträge im Rahmen von Veranstaltungen von Wyeth, Merk/MSD, Pfizer, Boehringer-Ingelheim, Roche, Gilead, Schering-Plough/Essex. Er ist beratend tätig für Wyeth, Schering-Plough/Essex, Gilead, Boehringer-Ingelheim und Merk/MSD.

M. Winkler erhielt Forschungsunterstützung von Bayer und Novartis; er ist beratend tätig für Astellas, Merk/MSD sowie Bayer und hielt Vorträge im Rahmen von Veranstaltungen von Merck/MSD, Bayer und Novartis.

C. Lass-Flörl erhielt Forschungsunterstützung von Pfizer, Gilead, Merk/MSD und Schering-Plough/Essex. Sie hielt Vorträge im Rahmen von Veranstaltungen von Pfizer, Gilead, Schering-Plough/Essex sowie Merk/MSD und ist beratend tätig für Pfizer und Schering-Plough/Essex.

M.A. Weigand hielt Vorträge im Rahmen vön Veranstaltungen von Astellas, AstraZeneca, Merk/MSD, Pfizer, Gilead, Schering-Plough/Essex und Wyeth. Er ist beratend tätig für Merk/MSD, Pfizer und Wyeth.

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Authors and Affiliations

  1. Klinik für Anaesthesiologie und Operative Intensivmedizin, Universitätsklinikum Gießen und Marburg, Standort Gießen, Rudolf-Buchheim Str. 7, 35392, Gießen, Deutschland

    C. Lichtenstern & M.A. Weigand

  2. Apotheke, Univerisitätsklinikum Heidelberg, Heidelberg, Deutschland

    S. Swoboda & T. Hoppe-Tichy

  3. Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie , Allgemeinchirurgie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland

    M. Hirschburger

  4. Institut für Medizinische Mikrobiologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland

    E. Domann

  5. Klinik für Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland

    M. Winkler

  6. Sektion für Hygiene und Medizinische Mikrobiologie, Department für Hygiene, Mikrobiologie und Sozialmedizin, Medizinische Universität Innsbruck, Innsbruck, Österreich

    C. Lass-Flörl

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  1. C. Lichtenstern
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  7. C. Lass-Flörl
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Correspondence to C. Lichtenstern.

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Lichtenstern, C., Swoboda, S., Hirschburger, M. et al. Update: invasive Pilzinfektionen. Anaesthesist 59, 30–52 (2010). https://doi.org/10.1007/s00101-009-1655-4

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