Universität zu Köln

von Lilienfeld-Toal, Marie, Wagener, Johannes ORCID: 0000-0002-5952-9422, Einsele, Hermann, Cornely, Oliver A. and Kurzai, Oliver (2019). Invasive Fungal Infection New Treatments to Meet New Challenges. Dtsch. Arztebl. Int., 116 (16). S. 271 - 285. COLOGNE: DEUTSCHER AERZTE-VERLAG GMBH. ISSN 1866-0452

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Abstract

Background: The incidence of invasive fungal infection is approximately 6 cases per 100 000 persons per year. It is estimated that only half of such infections are detected during the patient's lifetime, making this one of the more common overlooked causes of death in intensive-care patients. The low detection rate is due in part to the complexity of the diagnostic work-up, in which the clinical, radiological, and microbiological findings must be considered. Fungi with resistance to antimycotic drugs have been found to be on the rise around the world. Methods: This review is based on pertinent publications retrieved from a selective search in PubMed, with special attention to guidelines on the diagnosis and treatment of invasive fungal infections caused by Candida spp., Aspergillus spp., Mucorales, and Fusarium spp. Resufts: The clinical risk factors for invasive fungal infection include, among others, congenital immune deficiency, protracted (>10 days) marked granulocytopenia (<0.5 x 10(9)/L), allogeneic stem-cell transplantation, and treatment with immunosuppressive drugs or corticosteroids. High-risk groups include patients in intensive care and those with structural pulmonary disease and/or complicated influenza. The first line of treatment, supported by the findings of random ed clinical trials. consists of echinocandins for infections with Candida spp. (candidemia response rates: 75.6% for anidulafungin vs. 60.2% for fluconazole) and azole antimycotic drugs for infections with Aspergillus spp. (response rates: 52.8% for voriconazole vs. 31.6% for conventional amphotericin B). The recommended first-line treatment also depends on the local epidemiology. This challenge should be met by interdisciplinary collaboration. Therapeutic decision-making should also take account of the often severe undesired effects of antimycotic drugs (including impairment of hepatic and/or renal function) and the numerous interactions that some of them have with other drugs. Conclusion: Invasive fungal infections are often overlooked in routine hospital care. They should be incorporated into antimicrobial stewardship programs as an essential component. There is also a pressing need for the development of new classes of antimycotic drug.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code von Lilienfeld-Toal, Marie UNSPECIFIED UNSPECIFIED UNSPECIFIED Wagener, Johannes UNSPECIFIED orcid.org/0000-0002-5952-9422 UNSPECIFIED Einsele, Hermann UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, Oliver A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kurzai, Oliver UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-150539
DOI:	10.3238/arztebl.2019.0271
Journal or Publication Title:	Dtsch. Arztebl. Int.
Volume:	116
Number:	16
Page Range:	S. 271 - 285
Date:	2019
Publisher:	DEUTSCHER AERZTE-VERLAG GMBH
Place of Publication:	COLOGNE
ISSN:	1866-0452
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ESCMID-ASTERISK GUIDELINE; JOINT CLINICAL GUIDELINES; STEM-CELL TRANSPLANTATION; VIVO CONFOCAL MICROSCOPY; INTENSIVE-CARE-UNIT; WORKING PARTY AGIHO; HEMATOLOGICAL MALIGNANCIES; ECHINOCANDIN RESISTANCE; FUSARIUM KERATITIS; ORAL VORICONAZOLE Multiple languages Medicine, General & Internal Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/15053