Medizinische Klinik m S Onkologie u Hämatologie, Charité Universitätsmedizin, Charité, Campus Mitte, Berlin, Germany.
Mycoses. 2011 Jul;54(4):279-310. doi: 10.1111/j.1439-0507.2011.02040.x.
Invasive Candida infections are important causes of morbidity and mortality in immunocompromised and hospitalised patients. This article provides the joint recommendations of the German-speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMyKG) and the Paul-Ehrlich-Society for Chemotherapy (PEG) for diagnosis and treatment of invasive and superficial Candida infections. The recommendations are based on published results of clinical trials, case-series and expert opinion using the evidence criteria set forth by the Infectious Diseases Society of America (IDSA). Key recommendations are summarised here: The cornerstone of diagnosis remains the detection of the organism by culture with identification of the isolate at the species level; in vitro susceptibility testing is mandatory for invasive isolates. Options for initial therapy of candidaemia and other invasive Candida infections in non-granulocytopenic patients include fluconazole or one of the three approved echinocandin compounds; liposomal amphotericin B and voriconazole are secondary alternatives because of their less favourable pharmacological properties. In granulocytopenic patients, an echinocandin or liposomal amphotericin B is recommended as initial therapy based on the fungicidal mode of action. Indwelling central venous catheters serve as a main source of infection independent of the pathogenesis of candidaemia in the individual patients and should be removed whenever feasible. Pre-existing immunosuppressive treatment, particularly by glucocorticosteroids, ought to be discontinued, if feasible, or reduced. The duration of treatment for uncomplicated candidaemia is 14 days following the first negative blood culture and resolution of all associated symptoms and findings. Ophthalmoscopy is recommended prior to the discontinuation of antifungal chemotherapy to rule out endophthalmitis or chorioretinitis. Beyond these key recommendations, this article provides detailed recommendations for specific disease entities, for antifungal treatment in paediatric patients as well as a comprehensive discussion of epidemiology, clinical presentation and emerging diagnostic options of invasive and superficial Candida infections.
侵袭性念珠菌感染是免疫功能低下和住院患者发病率和死亡率的重要原因。本文提供了德语真菌学会（Deutschsprachige Mykologische Gesellschaft，DMyKG）和化学疗法欧洲研究组（Paul-Ehrlich-Society for Chemotherapy，PEG）联合发布的关于侵袭性和浅表性念珠菌感染诊断和治疗的建议。这些建议是基于临床试验、病例系列和使用美国传染病学会（Infectious Diseases Society of America，IDSA）提出的证据标准的专家意见得出的。主要建议总结如下：诊断的基石仍然是通过培养检测病原体，并对分离株进行种水平鉴定；对于侵袭性分离株，体外药敏试验是强制性的。非粒细胞减少症患者念珠菌血症和其他侵袭性念珠菌感染初始治疗的选择包括氟康唑或三种已批准的棘白菌素类药物之一；两性霉素 B 脂质体和伏立康唑是二线选择，因为它们的药理特性较差。粒细胞减少症患者，根据杀菌作用模式，建议使用棘白菌素类或两性霉素 B 脂质体作为初始治疗。无论患者念珠菌血症的发病机制如何，留置中央静脉导管都是感染的主要来源，应尽可能移除。如果可行，应停止或减少先前存在的免疫抑制治疗，特别是糖皮质激素。对于无并发症的念珠菌血症，在首次阴性血培养后和所有相关症状和发现得到解决后，治疗持续 14 天。建议在停止抗真菌化疗前进行眼科检查，以排除眼内炎或脉络膜视网膜炎。除了这些关键建议外，本文还为特定疾病实体、儿科患者的抗真菌治疗以及侵袭性和浅表性念珠菌感染的流行病学、临床表现和新兴诊断选择提供了详细建议。
