Antimycotic resistance in invasive fungal infections

A current study shows that the pathogen spectrum has changed in recent years and that more antifungal resistance is occurring.

More therapy options, but also more resistance incidences

Invasive fungal infections are still often detected too late and are therefore among the most common causes of death in intensive care patients. A current study also shows that the pathogen spectrum has changed in recent years and that more antifungal resistance is occurring.

The risk of invasive fungal infections is still underestimated in many cases. Such infections can quickly become life-threatening, especially for hospitalized and immunosuppressed patients.

In a recent paper published in the German "Medical Gazette" (Ärzteblatt), the authors point out that the therapeutic challenges of invasive fungal infections have also changed. Today, new or, comparable to the developments in bacterial pathogens, more and more resistant fungi can be observed. At the same time, however, the selection of available antimycotics has increased.

In addition, intensive care physicians today also have a rather completely different clientele than 20 years ago. The once homogeneous group of risk patients for invasive fungal infections is now much more heterogeneous. For example, patients with congenital immunodeficiencies, after allogeneic stem cell transplantation, immunosuppressed patients with medication, or patients with prednisone therapy are now risk patients. Finally, there are also classic intensive care patients, patients with lung diseases and those with influenza, some of which are difficult to treat.

In mycological diagnostics, interdisciplinary cooperation is becoming increasingly important. Today, for example, clinical, radiological and microbiological findings have to be taken into account when making a diagnosis. Which antimycotics are used when depends primarily on the occurrence of the infection. In addition, there are considerations about potentially serious side effects of antimycotics, primarily in the kidney and liver area. Also, numerous interactions of some of these fungicides with other therapeutics are now known.

Due to the increasing resistance to important antimycotic classes, both culture and sensitivity testing should be part of the laboratory routine in dealing with invasive fungal infections.

Source: 
von Lilienfeld-Toal M et al., Invasive fungal infection - new treatments to meet new challenges. Dtsch Arztebl Int 2019; 116: 271-278

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