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Diagnostik und Therapie invasiver Pilzinfektionen auf der Intensivstation

Diagnostics and therapy for invasive fungal infections in an intensive care unit

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Zusammenfassung

Invasive Pilzinfektionen sind mit einer hohen Letalität verbunden, und ihre Inzidenz steigt in den letzten Jahrzehnten an. Die Fungämie mit Candidaspezies und seltener die invasive pulmonale Aspergillose sind dabei die intensivmedizinisch bedeutsamsten Krankheitsbilder. Zu den Risikofaktoren für systemische Candidainfektionen zählen z. B. Breitspektrumantibiotika, eine lange intensivmedizinische Behandlung und eine Verletzung/Operation im Bereich des Gastrointestinaltraktes. Immunsupprimierte Patienten sind typischen Risikopatienten für eine invasive Aspergillusinfektion. Während die Diagnostik von invasiven Pilzinfektionen den Arzt weiterhin vor erhebliche Schwierigkeiten stellt, konnten in den letzten Jahren die Therapieoptionen verbessert werden. Neben Fluconazol, konventionellem und liposomalem Amphotericin B stehen neue Präparate wie Caspofungin und Voriconazol zur Verfügung. Um Antimykotika rational und kosteneffektiv einzusetzen, benötigt der Arzt Kenntnisse über ihre Indikationen und Grenzen. In diesem Beitrag sollen die Diagnostik und die aktuellen Therapieoptionen von intensivmedizinisch relevanten Aspergillus- und Candidainfektionen dargestellt werden.

Abstract

Invasive fungal infections are associated with a high mortality and have been increasing in incidence over the last few decades. Candidemia and, less commonly, invasive pulmonary aspergillosis are the most relevant fungal infections in critical care medicine. Risk factors for systemic Candida infections are the use of broad-spectrum antibiotics, a prolonged stay in an intensive care unit and gastrointestinal injury or surgery. Invasive aspergillosis usually occurs in immunocompromised patients. The diagnosis of invasive fungal infections remains challenging. The therapeutic spectrum includes fluconazol, conventional and liposomal amphotericin B, and the recently introduced agents caspofungin and voriconazol. For rational and cost-effective use, the clinician requires precise knowledge of the indications and limitations of these agents. This review focuses on the diagnostic and therapeutic options in severe Candida infections and invasive aspergillosis.

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Authors and Affiliations

  1. Zentralbereich für Krankenhaushygiene und Infektiologie, Universitätsklinikum Aachen, RWTH Aachen

    S. Koch, H. Haefner, F. Huenger & S. W. Lemmen

  2. Institut für Medizinische Mikrobiologie, Universitätsklinikum Aachen, RWTH Aachen

    G. Haase

  3. Klinik für Radiologische Diagnostik, Universitätsklinikum Aachen, RWTH Aachen

    J. Wildberger

  4. Zentralbereich für Krankenhaushygiene und Infektiologie, Universitätsklinikum Aachen, Medizinische Fakultät RWTH Aachen, Pauwelsstraße 30, 52057 , Aachen

    S. Koch

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  1. S. Koch
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  2. H. Haefner
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  3. F. Huenger
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  4. G. Haase
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Correspondence to S. Koch.

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Koch, S., Haefner, H., Huenger, F. et al. Diagnostik und Therapie invasiver Pilzinfektionen auf der Intensivstation. Anaesthesist 54, 1047–1066 (2005). https://doi.org/10.1007/s00101-005-0919-x

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  • DOI: https://doi.org/10.1007/s00101-005-0919-x

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