Zusammenfassung
Hintergrund
Invasive Pilzinfektionen, verursacht durch Candida oder Aspergillus, gehen mit einer hohen Mortalität einher. Kenntnisse über Risikofaktoren, Diagnosestellung und Therapiemanagement sind entscheidend, um das Überleben der Betroffenen zu verbessern.
Ziel der Arbeit
Praxisnaher Überblick über Risikofaktoren und therapeutisches Management von Infektionen mit Candida und Aspergillus sowie Ausblick auf neue antimykotische Substanzen.
Material und Methoden
Zusammenfassung relevanter Literatur und Empfehlungen zu Candidämie bzw. invasiver Candidiasis sowie zu invasiver und chronischer pulmonaler Aspergillose.
Ergebnisse
Erstlinientherapie der Candidämie bzw. invasiven Candidiasis sind Echinocandine wie Caspofungin, Anidulafungin oder Micafungin. Zur Bestimmung der Therapiedauer sind regelmäßige Blutproben für die Kultivierung abzunehmen. Ab dem Zeitpunkt der ersten negativen Kontrollblutkultur ist die Therapie noch für 14 Tage fortzuführen. Erstlinientherapie der invasiven pulmonalen Aspergillose sind Azole wie Voriconazol und Isavuconazol. Die Therapiedauer richtet sich nach der Schwere der Erkrankung und wird mit 6 bis 12 Wochen empfohlen. Bei der chronischen pulmonalen Aspergillose beträgt die Therapiedauer 6 bis 12 Monate. Ein therapeutisches Drugmonitoring ist für Voriconazol und Posaconazol empfohlen. Neue antimykotische Substanzen wie Olorofim, Fosmanogepix, Opelconazol, Rezafungin oder Ibrexafungerp werden in absehbarer Zeit das therapeutische Spektrum erweitern.
Schlussfolgerungen
Kenntnisse über Risikofaktoren und das richtige therapeutische Management sind entscheidend für das Überleben von Patienten mit invasiven Pilzinfektionen.
Abstract
Background
Invasive fungal infections caused by Candida or Aspergillus are associated with a high mortality. Knowledge about the risk factors, diagnosis and treatment management is crucial for improving the survival of those affected.
Objective
To give a practical overview about risk factors and treatment management of Candida and Aspergillus infections as well as providing an outlook on new antifungal agents.
Material and methods
Summary of the relevant literature and recommendations on candidemia and invasive candidiasis as well as invasive and chronic pulmonary aspergillosis.
Results
The first line treatment of candidemia and invasive candidiasis are echinocandins including caspofungin, anidulafungin and micafungin. Regular blood cultures have to be taken to determine the duration of treatment. After the first negative control blood culture treatment should be continued for another 14 days. The first line treatment of invasive pulmonary aspergillosis is azoles including voriconazole and isavuconazole. The duration of treatment depends on disease severity and is recommended for 6–12 weeks. The duration of treatment for chronic pulmonary aspergillosis is 6–12 months. Therapeutic drug monitoring is recommended for voriconazole and for posaconazole. New antifungal agents including olorofim, fosmanogepix, opelconazole, rezafungin or ibrexafungerp will broaden the therapeutic spectrum in the foreseeable future.
Conclusion
Knowledge about risk factors and the correct treatment management is crucial for the survival of patients with invasive fungal infections.
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H.J.F. Salzer gibt an, dass kein Interessenkonflikt besteht.
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Dieser Beitrag wurde in der Zeitschrift Medizinische Klinik - Intensivmedizin und Notfallmedizin (2023) 118(6):470–476. https://doi.org/10.1007/s00063-023-01051-6 erstveröffentlicht. Zweitpublikation mit freundlicher Genehmigung des Autors.
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Salzer, H.J.F. Antiinfektive Therapie von Pilzinfektionen durch Candida und Aspergillus. Wien klin Mag 27, 46–53 (2024). https://doi.org/10.1007/s00740-024-00526-2
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DOI: https://doi.org/10.1007/s00740-024-00526-2