Improving prevention and treatment strategies concerning opportunistic infections in immunocompromised hematologic patients

Focus on overtreatment in presumptive bacterial infections is increasing, while in the world of fungi and parasitic opportunistic infections sub-optimal treatment and delayed treatment initiation remains an important problem. There is often a delay in diagnostics because of the use of less sensitive tests such as fungal culture. These are time-consuming tests that are often only associated late. These opportunistic infections have high morbidity and mortality. Antifungal therapy is toxic with important interactions. There is an ever growing resistance. The duration of treatment is often unclear, which in combination with the side effects provides ground for poor compliance. In the next four years I want to focus on improving the prevention and treatment guidelines for opportunistic infections such as Mucormycosis, Aspergillosis and Toxoplasmosis. For my PhD I have an extensive biobank available with samples of bronchial aspirate, serum and urine from described haematological risk patients with deep and long-standing neutropenia after myelotoxic therapy as well as the immunocompromised patients after an allogeneic stem cell transplant. My study will start from a retro- and prospective data collection of Mucormycose infection with new PCR determination in contrast to the less sensitive culture. I will also analyze Toxoplasmosis reactivation in the new weekly single agent prophylaxis with Rezafungin - involving only Candida, Aspergillus and Pneumocystis species and dermatophytes - in the above-mentioned haematological patients at risk. I will also continue with two studies that were started and coordinated by my predecessor Dr. T. Mercier: 'Exhaled breath analysis for rapid diagnosis in opportunistic respiratory infections in hematological patients' and 'Registry of invasive aspergillosis in hematological patients'.