深入了解德国三级医疗中心的侵袭性真菌感染诊断和治疗能力。

IF 3.7 Q2 INFECTIOUS DISEASES
JAC-Antimicrobial Resistance Pub Date : 2024-05-29 eCollection Date: 2024-06-01 DOI:10.1093/jacamr/dlae083
Jon Salmanton-García, Michaela Simon, Andreas H Groll, Oliver Kurzai, Tobias Lahmer, Thomas Lehrnbecher, Maria Schroeder, Oliver A Cornely, Jannik Stemler
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引用次数: 0

摘要

导言:在德国,侵袭性真菌感染(IFI)的发病率不断上升,这是一个重大的健康问题,由于移植受者增多、人口老龄化以及免疫抑制药物的使用增加等因素,免疫系统受损的患者受到的影响尤为严重。诊断 IFI 仍然具有挑战性,将生物标志物检测方法纳入临床实践也很困难。以泛抗真菌念珠菌病例为代表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,为有针对性的干预措施铺平道路:从 2021 年 10 月至 2023 年 2 月,通过在线电子病例报告表收集数据。调查内容包括与真菌感染诊断和治疗相关的机构实践问题,并向全国的研究人员发出了邀请:研究调查了德国的 58 家医院。值得注意的是,77.6%的医院管理高风险的 IFI 患者。86%的医院拥有现场微生物实验室,但在高危患者方面存在显著差异(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%,而培养服务的总体覆盖率为 96%。抗原检测的覆盖率为 96%,抗体检测的覆盖率为 98%。PCR 检测的覆盖率为 98%。成像服务的覆盖率没有明显差异。根据患者情况,两性霉素 B 的配方存在差异。治疗药物监测在高风险患者医疗机构中更为常见(89.5% 对 50.0%)。所有接受分析的机构都报告了手术治疗情况(100%):结论:解决已发现的 IFI 诊断和治疗资源不均衡问题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,优化 IFI 的预防和治疗策略,强调公平获取资源的重要性,尤其是在高风险患者群体中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Insights into invasive fungal infection diagnostic and treatment capacities in tertiary care centres of Germany.

Introduction: 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 Candida auris 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.

Methods: 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.

Results: 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%).

Conclusions: 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.

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