Salmanton-García Jon, Simon Michaela, Groll Andreas H, Kurzai Oliver, Lahmer Tobias, Lehrnbecher Thomas, Schroeder Maria, Cornely Oliver A, Stemler Jannik
Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, University Hospital Cologne, Institute of Translational Research, Herderstraße 52, 50931 Cologne, Germany.
Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, University Hospital Cologne, Cologne, Germany.
JAC Antimicrob Resist. 2024 May 29;6(3):dlae083. doi: 10.1093/jacamr/dlae083. eCollection 2024 Jun.
In Germany, the growing incidence of invasive fungal infections (IFIs) is a significant health concern, particularly impacting individuals with compromised immune systems due to factors like increasing transplant recipients, an ageing population, and heightened use of immunosuppressive medications. Diagnosing IFI remains challenging, and the integration of biomarker assays into clinical practice is difficult. Antifungal resistance, exemplified by pan-antifungal-resistant cases, adds complexity to treatment. This study aims to provide a concise overview of the diagnostic and treatment landscape for IFI in Germany, identifying areas for improvement and paving the way for targeted interventions.
Data were collected using an online electronic case report form from October 2021 to February 2023. The survey included questions about institutional practices related to fungal infection diagnosis and treatment, with invitations extended to researchers nationwide.
The study surveyed 58 hospitals across Germany. Notably, 77.6% managed high-risk patients for IFI. While 86% had onsite microbiology labs, a significant difference was noted for high-risk patients (93% in specialized hospitals versus 62% in others). Microscopy services had 96% coverage, while overall access to culture was 96%. Antigen tests had 96% coverage, and antibody access was reported at 98%. PCR testing was available at 98%. Imaging access showed no significant access differences. Variability existed in amphotericin B formulations based on patient profiles. Therapeutic drug monitoring was more common in high-risk patient institutions (89.5% versus 50.0%). All analysed institutions reported access to surgery (100%).
Addressing identified disparities in diagnostic and therapeutic resources for IFI is crucial to improving patient outcomes. The study calls for ongoing research and collaboration to optimize strategies for the prevention and treatment of IFI, emphasizing the importance of equitable access to resources, especially in high-risk patient populations.
在德国，侵袭性真菌感染（IFI）发病率的不断上升是一个重大的健康问题，尤其对免疫系统因移植受者增加、人口老龄化以及免疫抑制药物使用增加等因素而受损的个体产生影响。IFI的诊断仍然具有挑战性，将生物标志物检测纳入临床实践也很困难。以泛抗真菌耐药病例为例的抗真菌耐药性增加了治疗的复杂性。本研究旨在简要概述德国IFI的诊断和治疗情况，确定需要改进的领域，并为有针对性的干预措施铺平道路。
2021年10月至2023年2月期间，通过在线电子病例报告表收集数据。该调查包括有关真菌感染诊断和治疗的机构实践的问题，并向全国的研究人员发出了邀请。
该研究对德国的58家医院进行了调查。值得注意的是，77.6%的医院负责管理IFI的高危患者。虽然86%的医院设有现场微生物实验室，但高危患者存在显著差异（专科医院为93%，其他医院为62%）。显微镜检查服务的覆盖率为96%，而总体培养检测率为96%。抗原检测的覆盖率为96%，抗体检测率报告为98%。PCR检测的可用性为98%。影像学检查的获取情况没有显著差异。基于患者情况，两性霉素B制剂存在差异。治疗药物监测在高危患者机构中更为常见（89.5%对50.0%）。所有分析的机构均报告可进行手术（100%）。
解决IFI诊断和治疗资源中已发现的差异对于改善患者预后至关重要。该研究呼吁持续开展研究与合作，以优化IFI的预防和治疗策略，强调公平获取资源的重要性，尤其是在高危患者群体中。
