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Strategien bei Versagen einer antimykotischen Therapie auf Intensivstation

Strategies for antifungal treatment failure in intensive care units

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Zusammenfassung

Epidemiologische Studien der letzten Jahre belegen sowohl eine steigende Inzidenz invasiver Pilzinfektionen als auch ein zunehmendes Problem mit Therapieversagen auf Intensivstationen. In bis zu 70 % der Fälle zeigt sich ein Nichtansprechen der primären antimykotischen Therapie abhängig von der auslösenden Spezies bzw. von vorliegenden Grunderkrankungen. Der vorliegende Review-Beitrag soll für das Thema des Therapieversagens sensibilisieren, die klinischen Umstände des Therapieversagens beschreiben sowie ein systematisches Vorgehen bei Verdacht auf ein Scheitern der primären antimykotischen Therapie vorschlagen.

Abstract

Recent epidemiologic studies reveal both an increasing incidence and an escalation in resistance of invasive fungal infections in intensive care units. Primary therapy fails in 70 % of cases, depending on the underlying pathogens and diseases. The purpose of this review is to raise awareness for the topic of antifungal therapy failure, describe the clinical conditions in which it occurs, and suggest a possible algorithm for handling the situation of suspected primary therapy failure.

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Abbreviations

AIDS:

„Acquired immune deficiency syndrome“

BAL:

Bronchoalveoläre Lavage

CARS:

„Compensatory anti-inflammatory response syndrome“

CVVHD:

Kontinuierliche venovenöse Hämodiafiltration

DMykG/PEG:

Deutschsprachige Mykologische Gesellschaft und Paul-Ehrlich-Gesellschaft

ESCMID:

European Society of Clinical Microbiology and Infectious Diseases

GFR:

Glomeruläre Filtrationsrate

IA:

Invasive Aspergillose

IDSA:

Infectious Diseases Society of America

IRIS:

„Immune reconstitution inflammatory syndrome“

SIRS:

„Systemic inflammatory response syndrome“

TCID:

T-Zell-Immundefizienz

TDM:

Therapeutisches Drug-Monitoring

ZVK:

Zentraler Venenkatheter

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    C. Arens, M.A. Weigand &  C. Lichtenstern

  2. Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland

    M. Bernhard

  3. Klinik für Anaesthesiologie und Operative Intensivmedizin, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland

    C. Koch

  4. Medizinische Mikrobiologie und Hygiene, Sektion Krankenhaus- und Umwelthygiene, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    A. Heininger

  5. Apotheke des Universitätsklinikums Heidelberg, Heidelberg, Deutschland

    D. Störzinger & T. Hoppe-Tichy

  6. Medizinische Klinik und Poliklinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland

    M. Hecker

  7. Stabsstelle „Klinische Mikrobiologie und Krankenhaushygiene“, Klinikum der Universität München, München, Deutschland

    B. Grabein

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C. Arens: Reisesponsoring von Gilead

M. Bernhard: kein Interessenkonflikt

C. Koch: Reisesponsoring von Pfizer Pharma und Beratertätigkeit für Astellas Pharma

A. Heininger: kein Interessenkonflikt

D. Störzinger: kein Interessenkonflikt

T. Hoppe-Tichy: Vortragshonorare und Beratertätigkeit für Basilea, BBraun, Novartis, Hexal, Roche

M. Hecker: kein Interessenkonflikt

B. Grabein: Vortragshonorare für Astellas Pharma, Astra Zeneca, Bayer, Becton Dickinson, Gilead, Janssen-Cilag, MSD Sharp & Dohme, Novartis, Pfizer; Beratertätigkeit für Astellas Pharma, Gilead, Bayer, MSD Sharp & Dohme, Pfizer Pharma

M.A. Weigand: Vortragshonorare und Beratertätigkeit für Astellas Pharma, MSD Sharp & Dohme, Pfizer Pharma, Novartis, Janssen, Gilead, Bayer, Astra Zeneca, Glaxo Smith Kline, Braun, Biosyn, Eli Lilly, ZLB Behring, Köhler Chemie

C. Lichtenstern: Vortragshonorare und Beratertätigkeit für Astellas Pharma, MSD Sharp & Dohme, Pfizer Pharma

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Arens, C., Bernhard, M., Koch, C. et al. Strategien bei Versagen einer antimykotischen Therapie auf Intensivstation. Anaesthesist 64, 643–658 (2015). https://doi.org/10.1007/s00101-015-0072-0

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