Therapie der ambulant erworbenen und nosokomialen Pneumonie

2019 ◽  
Vol 48 (11) ◽  
pp. 462-468 ◽  
Author(s):  
Evelyn Kramme ◽  
Klaus Dalhoff ◽  
Santiago Ewig
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Antibiotic Stewardship ◽  
Community Acquired Pneumonia ◽  
Ambulant Erworbene Pneumonie ◽  
Nosokomiale Pneumonie ◽  
Antibiotic Stewardship Abs

ZUSAMMENFASSUNGDie ambulant erworbene Pneumonie (community-acquired pneumonia, CAP) ist weltweit die häufigste vital bedrohliche Infektion. In Deutschland wird sie mit zunehmender Alterung der Gesellschaft mehr und mehr zu einer geriatrischen Erkrankung. Entscheidend für die Therapie ist die Schweregradbeurteilung, die nach dem CRB65-Score erfolgt. In der Klinik wird zur Abklärung der Ätiologie eine mikrobiologische Basisdiagnostik empfohlen, diese besteht aus respiratorischer Kultur, Blutkulturen, bei mittelschwerer und insbesondere schwerer Pneumonie auch dem Legionellen-Antigentest im Urin. Weitere Tests sind nach anamnestischen Hinweisen gezielt einzusetzen. Die Auswahl der Therapie wird bei der CAP in erster Linie vom Schweregrad bestimmt. Die Therapiedauer sollte bei CAP nicht mehr als 5–7 Tage betragen.Die nosokomiale Pneumonie spielt eine Hauptrolle unter den im Krankenhaus erworbenen Infektionen. Die Mehrzahl der Fälle tritt bei beatmeten Patienten auf. Anders als bei der CAP prägen „Problemkeime“ wie Staphylococcus aureus, Enterobakterien und Pseudomonas aeruginosa das Erregerspektrum der nosokomialen Pneumonie. Eine Zunahme multiresistenter Erreger (MRE) wird weltweit beobachtet. Die Wahl der kalkulierten Therapie erfolgt nach dem MRE-Risiko und dem Schweregrad der Infektion. Eine regelhafte initiale Kombinationstherapie wird nur noch dann empfohlen, wenn sowohl ein erhöhtes MRE-Risiko als auch Schweregradkriterien vorliegen. Deeskalation und Antibiotic Stewardship (ABS) sind integraler Bestandteil des Therapiekonzepts, dabei geht es vorrangig um die Begrenzung des Antibiotikaeinsatzes.

scholarly journals Multimicrobial Pneumonia during the Early Stages of a Global Pandemic

2021 ◽  
Vol 8 (6) ◽  
Author(s):  
Jalal H ◽  
◽  
Henriksen G ◽  
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Acute Infection ◽  
Standard Of Care ◽  
Antibiotic Use ◽  
Lung Parenchyma ◽  
Community Acquired Pneumonia ◽  
Methicillin Resistant ◽  
Global Pandemic

Community-acquired pneumonia is an acute infection of lung parenchyma which causes local and systemic inflammatory changes via cytokines. Several bacteria and viruses are responsible for this type of pneumonia, and the most common bacterial cause is Streptococcus pneumoniae. The classic symptoms are cough, fever, and pleuritic chest pain. In the Winter of 2020, a new strain of coronavirus known as SARS-CoV-2 spread throughout the world and was responsible for a global pandemic that transformed the way we live our lives. A 93-year old female presented to the hospital with respiratory distress and was found to have not only COVID-19 pneumonia but also superimposed Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa pneumonia. Following the most up-to-date guidelines, she was determined to have community-acquired pneumonia. Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa are uncommon causes of communityacquired pneumonia. She was treated with the standard of care at the time, which included vancomycin, piperacillin-tazobactam, and hydroxychloroquine. This case highlights the rarity of this specific presentation of community acquired pneumonia in regards to microbial etiology. It showcases that patients may develop certain diseases despite not having any risk factors. A major takeaway point is that apt decision making is a critical and time sensitive matter when determining whether a bacterial co-infection is present since it can affect patient outcomes. Since co-infections are relatively infrequent, antibiotic use in COVID-19 positive patients needs to be tailored accordingly. At the same time, it is crucial to keep in mind that co-infections are associated with increased severity of COVID-19 as well as poorer outcomes.

scholarly journals Pola Kuman dan Uji Kepekaan pada Pasien Community Acquired Pneumonia di RSUP Dr. M. Djamil Padang Tahun 2016

2019 ◽  
Vol 8 (3) ◽  
pp. 553
Author(s):  
Narlis Narlis ◽  
Ellyza Nasrul ◽  
Efrida Efrida
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Staphylococcus Epidermidis ◽  
Community Acquired Pneumonia ◽  
Klebsiella Pneumonia ◽  
Proteus Vulgaris ◽  
Streptococcus Pneumonia

Community acquired pneumonia (CAP) merupakan infeksi yang paling sering menyebabkan sepsis dan dapat menimbulkan kematian. Pertimbangan pemilihan antimikroba yang tepat dan menghindari penggunaan yang berlebihan perlu dilakukan untuk mencegah terjadinya resistensi. Tujuan penelitian ini adalah mengetahui pola kuman dan uji kepekaan pasien CAP di RSUP Dr. M. Djamil Padang. Penelitian ini merupakan penelitian deskriptif retrospektif terhadap 201 sampel sputum pasien CAP yang diperiksa kultur kemudian dilanjutkan dengan pewarnaan Gram dan uji biokimia untuk mengidentifikasi bakteri. Uji kepekaan antimikroba menggunakan metode difusi cakram. Penelitian dilakukan di Laboratorium Sentral RSUP Dr. M. Djamil Padang periode Januari 2016 hingga Desember 2016. Data ditampilkan dalam bentuk tabel distribusi frekuensi. Mikroorganisme yang ditemukan adalah Klebsiella pneumonia (55,23%), Staphylococcus aureus (25,87%), Streptococcus pneumonia (7,96%), Pseudomonas aeruginosa (5,97%), Staphylococcus epidermidis (2,9%), Acinetobacter baumani (1,99%), Proteus vulgaris (0,49%). Antimikroba yang paling sensitif adalah Meropenem (78,7%), sedangkan antimikroba resisten dengan persentase tertinggi adalah Ampisilin (90%), Amoksisilin (89,4%), Eritromisin (73,5%), Amoksisilin + Klavulanat (64,6%), dan Kloramfenikol (61,7%). Mikroorganisme yang paling banyak ditemukan adalah Klebsiella pneumonia (55,23%). Meropenem merupakan antimikroba sensitif dengan persentase paling tinggi (78,7%) sedangkan antimikroba resisten dengan persentase paling tinggi adalah ampisilin (90%).

Antibiotic Stewardship bei ambulant erworbener Pneumonie

2020 ◽  
Vol 145 (06) ◽  
pp. 383-392
Author(s):  
Fabian Leo ◽  
Miriam Songa Stegemann ◽  
Florian Maurer
Keyword(s):  
Antibiotic Stewardship ◽  
Community Acquired Pneumonia ◽  
Audit And Feedback ◽  
Quality Of Prescribing ◽  
Computer Based ◽  
Prospective Audit And Feedback ◽  
Antibiotic Stewardship Abs ◽  
Inpatient And Outpatient Care ◽  
Continuous Measures

AbstractAntibiotic stewardship (ABS) denotes structured and continuous measures to improve the quality of prescribing anti-infectives. The aim is to achieve optimal treatment results and to minimize undesirable effects, especially the emergence of antibiotic resistance. This review summarizes the most important ABS principles based on recently published studies with implications for the management of community-acquired pneumonia. Local guidelines, education and training and “prospective audit and feedback” are established strategies to improve the management of patients with community-acquired pneumonia. However, the implementation of ABS programs requires trained personnel and may be impeded by limited structural and time resources. Hence, electronic health records and computer-based interventions are useful support for ABS programs and offer potential to facilitate ABS in inpatient and outpatient care. PCR-based rapid diagnostic tests, PCT-guided algorithms and penicillin allergy testing are suitable procedures to supplement ABS programs.

scholarly journals COMMUNITY-ACQUIRED PNEUMONIA IN INFECTIOUS HOSPITAL PATIENTS: THE DEVELOPMENT OF RESISTANCE TO ANTIMICROBIALS

2018 ◽  
Vol 23 (3) ◽  
pp. 108-113
Author(s):  
Marina G. Avdeeva ◽  
G. V. Shubina ◽  
A. A. Ganzha ◽  
E. V. Zhuravleva
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Antimicrobial Agents ◽  
Resistance Mechanisms ◽  
Community Acquired Pneumonia ◽  
Diffusion Method ◽  
Individual Risk ◽  
Beta Lactam ◽  
Local Data ◽  
Antimicrobial Drugs

The aim of the work was to study the structure, level and dynamics of resistance to antimicrobial drugs of the most common types of microorganisms in patients with community-acquired pneumonia (CAP) in the Krasnodar Territory, on the example of patients treated in a regional specialized infectious hospital for the period 2015-2017. Materials and methods. The results of bacteriological tests of expectoration, including 523 positive strains of microorganisms, are analyzed. The analysis does not include strains with hospital multidrug resistance. A bacterioscopy with Gram stain and sputum seeding on plate-like artificial nutrient media were carried out. Identification of the pathogen was performed by mass spectrometry using MALDI-TOF technology (Microflex LT, Bruker, Germany), phenotypically identified resistance mechanisms were confirmed on the automatic analyzer Vitek II Compact (BioMérieux, France). The sensitivity to antimicrobials was determined by the disc-diffusion method in the Müller-Hinton medium, using the disks by Bio-Rad, France. The antibioticogram was analyzed on the apparatus “Adagio” (Bio-Rad, France). Results. In the etiologic structure of community-acquired pneumonia, Streptoccocus pneumonia prevails in patients hospitalized in an infectious hospital in the Krasnodar Territory, which is determined in 73.56% of confirmed cases, which is twice as high as an average in Russia. Staphylococcus aureus was determined in 9.04% of casesd, with fluctuations in different years from 3.8% to 12.1%. Klebsiella pneumoniae was found in 4.61%, with variations from 1.7% to 9.3%. Pseudomonas aeruginosa was registered in 4.6%, altered from 1.3% to 7.8%. Other microorganisms were represented with Enterobacteriaceae family, 8.2% of the cases. The resistance of wild strains of microorganisms isolated at CAP to a number of antimicrobial agents has been established. A number of negative trends were noted: the emergence of pneumococcal strains resistant to beta-lactam antimicrobial drugs (benzylpenicillin MIC < 2μg); an increase in the resistance of pneumococci to macrolides, tetracyclines, sulfonamides. There is a high percentage of Staphylococcus aureus (80%) producing penicillinase, and an increase in their resistance to macrolides. A high level of Pseudomonas aeruginosa resistance to 3-rd and 4-th generation cephalosporins is noted. Conclusion. The obtained data determine the need for further monitoring of regional resistance of microorganisms, which will allow both adequate start therapy and the possibility of its timely correction. In the practical work of a doctor, it is important not only to be guided by local data on the resistance of microorganisms to antimicrobial drugs, but also to analyze the possible causes of its occurrence with the establishment of individual risk factors.

scholarly journals 1301. Risk Factors for Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa in Community Acquired Pneumonia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S738-S739
Author(s):  
Maya Bell ◽  
Courtney Veltri ◽  
Evelina Kolychev ◽  
Leila S Hojat
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Risk Factor ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Academic Medical Center ◽  
Community Acquired Pneumonia ◽  
Methicillin Resistant ◽  
Independent Risk Factors ◽  
The Impact

Abstract Background The 2019 American Thoracic Society and Infectious Diseases Society of America Community-Acquired Pneumonia (CAP) guidelines concluded that the major risk factors for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PsA) include prior isolation of these organisms and previous hospitalization with IV antibiotic use within 90 days. However, the guidelines recognized that results may vary by region and recommended local validation of risk factors. The primary objective of this study was to determine which potential risk factors are associated with MRSA and Pseudomonas aeruginosa in CAP in our institution. This study also evaluated appropriateness of antibiotics used for empiric CAP therapy. Methods This was a single-center, retrospective cohort study performed in an urban academic medical center in Cleveland, OH. Adults hospitalized for CAP who had a respiratory culture performed between January 2016 and September 2020 were included. Patients were randomized in a 1:1:1 ratio into MRSA, PsA, and non-resistant CAP (NR-CAP) groups. Patients with bacterial co-infections or resistant pathogens other than MRSA or PsA were excluded. Results The study included 111 patients with 37 patients in each group. The median age was 61 years (IQR 52-70), and 58.6% of patients were male. There were no independent risk factors for MRSA (Table 1). Independent risk factors for PsA included prior isolation and enteral feeding (Table 2). MRSA risk factors as defined by the 2019 CAP guidelines were found in 48.6% of patients with MRSA CAP (Figure 1). Guideline-defined PsA risk factors were found in 56.8% of patients with PsA CAP (Figure 2). In NR-CAP, 62.2% received empiric MRSA coverage while only 27% had a guideline-defined risk factor; PsA coverage was administered in 78.4% of NR-CAP patients, but risk factors were found in only 24.3% of this cohort. MRSA and P. aeruginosa Risk Factor Analyses Empiric MRSA and P. aeruginosa Coverage and Guideline-Defined Risk Factors Conclusion Our findings were consistent with the risk factors identified in the 2019 CAP guidelines, but additional risk factors may be present in our patient population. Empiric coverage for MRSA and PsA was disproportionately high relative to the rate of recovery. This study encourages local validation of risk factors; however, further analyses are needed to determine the impact on empiric therapy. Disclosures All Authors: No reported disclosures

scholarly journals Pola Kuman dan Uji Kepekaan pada Pasien Community Acquired Pneumonia di RSUP Dr. M. Djamil Padang Tahun 2016

2019 ◽  
Vol 8 (3) ◽  
pp. 553
Author(s):  
Narlis Narlis ◽  
Ellyza Nasrul ◽  
Efrida Efrida
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Staphylococcus Epidermidis ◽  
Community Acquired Pneumonia ◽  
Klebsiella Pneumonia ◽  
Proteus Vulgaris ◽  
Streptococcus Pneumonia

Community acquired pneumonia (CAP) merupakan infeksi yang paling sering menyebabkan sepsis dan dapat menimbulkan kematian. Pertimbangan pemilihan antimikroba yang tepat dan menghindari penggunaan yang berlebihan perlu dilakukan untuk mencegah terjadinya resistensi. Tujuan penelitian ini adalah mengetahui pola kuman dan uji kepekaan pasien CAP di RSUP Dr. M. Djamil Padang. Penelitian ini merupakan penelitian deskriptif retrospektif terhadap 201 sampel sputum pasien CAP yang diperiksa kultur kemudian dilanjutkan dengan pewarnaan Gram dan uji biokimia untuk mengidentifikasi bakteri. Uji kepekaan antimikroba menggunakan metode difusi cakram. Penelitian dilakukan di Laboratorium Sentral RSUP Dr. M. Djamil Padang periode Januari 2016 hingga Desember 2016. Data ditampilkan dalam bentuk tabel distribusi frekuensi. Mikroorganisme yang ditemukan adalah Klebsiella pneumonia (55,23%), Staphylococcus aureus (25,87%), Streptococcus pneumonia (7,96%), Pseudomonas aeruginosa (5,97%), Staphylococcus epidermidis (2,9%), Acinetobacter baumani (1,99%), Proteus vulgaris (0,49%). Antimikroba yang paling sensitif adalah Meropenem (78,7%), sedangkan antimikroba resisten dengan persentase tertinggi adalah Ampisilin (90%), Amoksisilin (89,4%), Eritromisin (73,5%), Amoksisilin + Klavulanat (64,6%), dan Kloramfenikol (61,7%). Mikroorganisme yang paling banyak ditemukan adalah Klebsiella pneumonia (55,23%). Meropenem merupakan antimikroba sensitif dengan persentase paling tinggi (78,7%) sedangkan antimikroba resisten dengan persentase paling tinggi adalah ampisilin (90%).

scholarly journals COMMUNITY-ACQUIRED PNEUMONIA IN INFECTIOUS HOSPITAL PATIENTS: THE DEVELOPMENT OF RESISTANCE TO ANTIMICROBIALS

2018 ◽  
Vol 23 (3) ◽  
pp. 108-113
Author(s):  
Marina G. Avdeeva ◽  
G. V. Shubina ◽  
A. A. Ganzha ◽  
E. V. Zhuravleva
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Antimicrobial Agents ◽  
Resistance Mechanisms ◽  
Community Acquired Pneumonia ◽  
Diffusion Method ◽  
Individual Risk ◽  
Beta Lactam ◽  
Local Data ◽  
Antimicrobial Drugs

The aim of the work was to study the structure, level and dynamics of resistance to antimicrobial drugs of the most common types of microorganisms in patients with community-acquired pneumonia (CAP) in the Krasnodar Territory, on the example of patients treated in a regional specialized infectious hospital for the period 2015-2017. Materials and methods. The results of bacteriological tests of expectoration, including 523 positive strains of microorganisms, are analyzed. The analysis does not include strains with hospital multidrug resistance. A bacterioscopy with Gram stain and sputum seeding on plate-like artificial nutrient media were carried out. Identification of the pathogen was performed by mass spectrometry using MALDI-TOF technology (Microflex LT, Bruker, Germany), phenotypically identified resistance mechanisms were confirmed on the automatic analyzer Vitek II Compact (BioMérieux, France). The sensitivity to antimicrobials was determined by the disc-diffusion method in the Müller-Hinton medium, using the disks by Bio-Rad, France. The antibioticogram was analyzed on the apparatus “Adagio” (Bio-Rad, France). Results. In the etiologic structure of community-acquired pneumonia, Streptoccocus pneumonia prevails in patients hospitalized in an infectious hospital in the Krasnodar Territory, which is determined in 73.56% of confirmed cases, which is twice as high as an average in Russia. Staphylococcus aureus was determined in 9.04% of casesd, with fluctuations in different years from 3.8% to 12.1%. Klebsiella pneumoniae was found in 4.61%, with variations from 1.7% to 9.3%. Pseudomonas aeruginosa was registered in 4.6%, altered from 1.3% to 7.8%. Other microorganisms were represented with Enterobacteriaceae family, 8.2% of the cases. The resistance of wild strains of microorganisms isolated at CAP to a number of antimicrobial agents has been established. A number of negative trends were noted: the emergence of pneumococcal strains resistant to beta-lactam antimicrobial drugs (benzylpenicillin MIC < 2μg); an increase in the resistance of pneumococci to macrolides, tetracyclines, sulfonamides. There is a high percentage of Staphylococcus aureus (80%) producing penicillinase, and an increase in their resistance to macrolides. A high level of Pseudomonas aeruginosa resistance to 3-rd and 4-th generation cephalosporins is noted. Conclusion. The obtained data determine the need for further monitoring of regional resistance of microorganisms, which will allow both adequate start therapy and the possibility of its timely correction. In the practical work of a doctor, it is important not only to be guided by local data on the resistance of microorganisms to antimicrobial drugs, but also to analyze the possible causes of its occurrence with the establishment of individual risk factors.

Risk Factor Evaluation for Methicillin-Resistant Staphylococcus aureus and Pseudomonas aeruginosa in Community-Acquired Pneumonia

2020 ◽  
Vol 55 (1) ◽  
pp. 36-43
Author(s):  
Paul O. Lewis
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Substance Use ◽  
Risk Factor ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Community Acquired Pneumonia ◽  
Lung Abscess ◽  
Illicit Substance Use ◽  
Local Risk

Background: The 2019 community-acquired pneumonia guidelines recommend using recent respiratory cultures and locally validated epidemiology plus risk factor assessment to determine empirical coverage of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. Objective: To develop a methodology for evaluating local epidemiology and validating local risk factors for P aeruginosa and MRSA. Methods: This multicenter, retrospective cohort evaluated adult patients admitted for pneumonia. Risk factors for MRSA and P aeruginosa were evaluated using multivariable logistic regression and reported as adjusted odds ratios (aORs). Results: There were 10 723 cases evaluated. Lung abscess/empyema had the highest odds associated with MRSA (aOR = 4.24; P < 0.0001), followed by influenza (aOR = 2.34; P = 0.01), end-stage renal disease (ESRD; aOR = 2.09; P = 0.006), illicit substance use (aOR = 1.7; P = 0.007), and chronic obstructive pulmonary disease (COPD; aOR = 1.26; P = 0.04). For P aeruginosa, the highest odds were in bronchiectasis (aOR = 6.13; P < 0.0001), lung abscess/empyema (aOR = 3.36; P = 0.005), and COPD (aOR = 1.84; P < 0.0001). Isolated COPD without other risk factors did not pose an increased risk of either organism. Conclusion and Relevance: Influenza, ESRD, lung abscess/empyema, and illicit substance use were local risk factors for MRSA. Bronchiectasis and lung abscess/empyema were risk factors for Pseudomonas. COPD was associated with MRSA and Pseudomonas. However, isolated COPD had similar rates of MRSA and Pseudomonas pneumonia compared with the total population. This study established a feasible methodology for evaluating local risk factors.

Krankenhaushygiene - Antibiotic Stewardship

2017 ◽  
Vol 22 (12) ◽  
pp. 64-66
Author(s):  
Peter Walger
Keyword(s):  
Antibiotic Stewardship ◽  
Antibiotic Stewardship Abs

Hygienemaßnahmen sind wichtig, richtig und unbedingt notwendig. Aber sie sind nur eine Seite der Medaille, um Infektionen zu verhindern. Die andere Seite ist die optimale Therapie von Infektionen. Unter dem Strategiebegriff „Antibiotic Stewardship“ (ABS) gibt es inzwischen zahlreiche Leitlinien und Empfehlungen für einen sinnvollen Antibiotikagebrauch. Eine Klinik ist gut beraten, in ABS zu investieren, denn die positiven Effekte auf das klinische und ökonomische Outcome sind nicht von der Hand zu weisen.

Case of a diabetic man cured from rhinocerebral zygomycosis

2010 ◽  
Vol 151 (39) ◽  
pp. 1591-1596
Author(s):  
Botond Lakatos ◽  
Radka Nikolova ◽  
László Ocskay ◽  
Judit Csomor ◽  
Gyula Prinz
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Amphotericin B ◽  
Rhizopus Oryzae

A zygomycosis (mucormycosis) ritka, kifejezetten agresszív lefolyású opportunista infekció, amelyet a Zygomycota (Járomspórás gombák) törzs Zygomycetes osztályába tartozó gombák okoznak. Jellemzően immunhiány, neutropenia, vastúlterhelés, hematológiai betegség, illetve diabeteses ketoacidosis eseteiben fordul elő. Esetismertetés: A szerzők 18 éves, 9 éve inzulindependens diabetes mellitusban szenvedő, rossz compliance-szel rendelkező beteg kórtörténetét ismertetik. Súlyos állapotban, beszűkült tudattal, ketoacidosisban, orrmelléküreg-gyulladásra utaló egyoldali periorbitalis duzzanattal, bőrpírral került kórházba. Bár az endoszkópos sinusműtét során vett váladékból methicillinrezisztens Staphylococcus aureus és Pseudomonas aeruginosa tenyészett, a beteg anamnézise, klinikuma zygomycosis gyanúját keltette, emiatt amphotericin-B-kezelést indítottak. Szövettani, illetve mikrobiológiai vizsgálatok során Rhizopus oryzae okozta invazív infekció igazolódott. Megbeszélés: Az antifungális kezelés ismételt sebészeti beavatkozásokkal és adjuváns granulocytakolónia-stimuláló faktor alkalmazásával kiegészítve eredményesnek bizonyult. A beteg négy hónappal hazabocsátását követően él és panaszmentes. Orv. Hetil., 2010, 39, 1591–1596.

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