Insights into invasive fungal infection diagnostic and treatment capacities in tertiary care centres of Germany

Jon Salmanton-García; Michaela Simon; Andreas H Groll; Oliver Kurzai; Tobias Lahmer; Thomas Lehrnbecher; Maria Schroeder; Oliver A Cornely; Jannik Stemler

doi:10.1093/jacamr/dlae083

Insights into invasive fungal infection diagnostic and treatment capacities in tertiary care centres of Germany

JAC Antimicrob Resist. 2024 May 29;6(3):dlae083. doi: 10.1093/jacamr/dlae083. eCollection 2024 Jun.

Authors

Jon Salmanton-García^{1

2

3}, Michaela Simon⁴, Andreas H Groll⁵, Oliver Kurzai⁶, Tobias Lahmer⁷, Thomas Lehrnbecher⁸, Maria Schroeder⁹, Oliver A Cornely^{1

2

3

10}, Jannik Stemler^{1

2

3}

Affiliations

¹ 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.
² 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.
³ German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
⁴ Institute for Medical Microbiology, Immunology, and Hygiene, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany.
⁵ Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology, Children's University Hospital Münster, Münster, Germany.
⁶ National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knoell Institute, Jena, Germany.
⁷ TUM School of Medicine and Health, Department of Clinical Medicine-Clinical Department for Internal Medicine II, University Medical Centre, Technical University of Munich, Munich, Germany.
⁸ Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt am Main, Germany.
⁹ Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁰ Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, University Hospital Cologne, Cologne, Germany.

Abstract

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.