Invasive Pilzinfektionen bei Intensivpatienten – Was gibt es Neues?

Was ist neu?

Invasive Candida-Infektionen Invasive Mykosen spielen in der Intensivmedizin eine zunehmende Rolle. Das Erkennen von Risikopatienten und das richtige Diagnose- und Therapiemanagement spielen dabei die entscheidende Rolle.

Influenza- und COVID-19-assoziierte pulmonale Aspergillose Neben der invasiven Candidiasis wurden zuletzt vermehrt Superinfektionen durch Schimmelpilze im Rahmen von schweren Influenza- und COVID-19-Infektionen beobachtet. Diese treten ohne die „klassischen“ Risikofaktoren für invasive Aspergillosen auf und bedürfen daher der besonderen Aufmerksamkeit der Intensivmediziner. Die Superinfektion mit Aspergillus-Spezies bei Influenza ist insofern neu, da bislang invasive Aspergillosen nur bei immunsupprimierten Patienten beschrieben wurden. Auch bei SARS-CoV-2 fanden sich schnell Berichte von COVID-19-assoziierten pulmonalen Aspergillosen, die möglicherweise zu einer Erhöhung der Mortalität führen können.

Abstract

Invasive fungal infections are gaining increasing importance in intensive care medicine. The aim of this article is to present an update on recent developments in the field of invasive fungal infection in critically ill patients. Particular emphasis is placed on the recently described invasive mold infections in patients with acute respiratory distress syndrome due to influenza or COVID-19. Detecting high-risk patients and the optimal diagnostic and therapeutic strategies play a decisive role to improve outcome.

Schlüsselwörter

invasive Pilzinfektion - Intensivstation - COVID-19 - Influenza - Aspergillose

Key words

invasive fungal infection - intensive care unit - COVID-19 - influenza - aspergillosis

Publication History

Article published online:
29 March 2021

• Literatur

• 1 Meyer E, Geffers C, Gastmeier P. et al No increase in primary nosocomial candidemia in 682 German intensive care units during 2006 to 2011. Euro Surveill 2013; 18: 20505
• 2 Martin-Loeches I, Antonelli M, Cuenca-Estrella M. et al ESICM/ESCMID task force on practical management of invasive candidiasis in critically ill patients. Intensive care medicine 2019; 45: 789-805 . doi:10.1007/s00134-019-05599-w
• 3 Pappas PG, Kauffman CA, Andes DR. et al Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62: e1-e50 . doi:10.1093/cid/civ933
• 4 Koehler P, Stecher M, Cornely OA. et al Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis. Clin Microbiol Infect 2019; 25: 1200-1212 . doi:10.1016/j.cmi.2019.04.024
• 5 Koehler P, Denis B, Denning DW. et al European confederation of medical mycology expert consult-An ECMM excellence center initiative. Mycoses 2020; 63: 566-572 . doi:10.1111/myc.13076
• 6 Schauwvlieghe A, Rijnders BJA, Philips N. et al Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med 2018; 6: 782-792 . doi:10.1016/S2213-2600(18)30274-1
• 7 Donnelly JP, Chen SC, Kauffman CA. et al Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis 2020; 71: 1367-1376 . doi:10.1093/cid/ciz1008
• 8 Verweij PE, Rijnders BJA, Bruggemann RJM. et al Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion. Intensive Care Med 2020; 46: 1524-1535 . doi:10.1007/s00134-020-06091-6
• 9 Koehler P, Cornely OA, Bottiger BW. et al COVID-19 associated pulmonary aspergillosis. Mycoses 2020; 63: 528-534 . doi:10.1111/myc.13096
• 10 Bartoletti M, Pascale R, Cricca M. et al Epidemiology of invasive pulmonary aspergillosis among COVID-19 intubated patients: a prospective study. Clin Infect Dis 2020;
• 11 White PL, Dhillon R, Cordey A. et al A national strategy to diagnose COVID-19 associated invasive fungal disease in the ICU. Clin Infect Dis 2020;
• 12 Arastehfar A, Carvalho A, van de Veerdonk FL. et al COVID-19 Associated Pulmonary Aspergillosis (CAPA)-From Immunology to Treatment. J fungi (Basel) 2020; 6
• 13 Wahidi MM, Shojaee S, Lamb CR. et al The Use of Bronchoscopy During the Coronavirus Disease 2019 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. Chest 2020; 158: 1268-1281 . doi:10.1016/j.chest.2020.04.036
• 14 Koehler P, Cornely OA, Kochanek M. Bronchoscopy safety precautions for diagnosing COVID-19 associated pulmonary aspergillosis-A simulation study. Mycoses 2021; 64: 55-59 . doi:10.1111/myc.13183
• 15 Koehler P, Bassetti M, Chakrabarti A. et al Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis 2020
• 16 Wahidi MM, Lamb C, Murgu S. et al American Association for Bronchology and Interventional Pulmonology (AABIP) Statement on the Use of Bronchoscopy and Respiratory Specimen Collection in Patients With Suspected or Confirmed COVID-19 Infection. J Bronchology Interv Pulmonol 2020; 27: e52-e54 . doi:10.1097/LBR.0000000000000681
• 17 Patterson TF, Thompson 3rd GR, Denning DW. et al Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 63: e1-e60 . doi:10.1093/cid/ciw326 [doi]
• 18 Ullmann AJ, Aguado JM, Arikan-Akdagli S. et al Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 2018; 24 (Suppl. 01) e1-e38 . doi:10.1016/j.cmi.2018.01.002
• 19 Koehler P, Bassetti M, Kochanek M. et al Intensive care management of influenza-associated pulmonary aspergillosis. Clin Microbiol Infect 2019; 25: 1501-1509 . doi:10.1016/j.cmi.2019.04.031