O R G A N I S A T I E - E N C O N G R E S B U R E A U Organisatie- en Congresbureau InterActie BV Stationsweg 73 c 6711 PL Ede Telefoon: 0318-693501 Fax: 0318-693365 E-mail: info@interactie.org Website: www.interactie.org Sinds augustus 2006 is Interactie officieel erkend door de Vereniging van Nederlandse Congres- en Vergaderbelangen (VNC). De erkenningsregeling van de VNC is een keurmerk dat borg staat voor kwalitatieve dienstverlening en bekwaamheid van personeel. InterActie behoort daarmee tot één van de elf erkende congresorganisatiebureaus in Nederland. Al meer dan 10 jaar heeft congres- en organisatiebureau InterActie ervaring in het organiseren van evenementen. Van 10 tot 3200 deelnemers. InterActie verzorgt met 7 werknemers de volledige administratieve dienstverlening als het vaste congresbureau van de Nederlandse Vereniging voor Intensive Care. Naast NVIC wordt ook aan andere verenigingen en organisaties uit de medische- en ICT sector ondersteuning geboden. Meer informatie over InterActie: www.interactie.org De NVIC feliciteert Congres- en Organisatiebureau InterActie met het behalen van de status van Erkend Congresbureau
netherlands journal of critical care Copyright ©2006, Nederlandse Vereniging voor Intensive Care. All Rights Reserved. r o u n d t a b l e New perspectives in the treatment of severe yeast- and fungal infections in critically ill patients: the role of Mycograb® K.H. Polderman 1 , A.R.H. van Zanten 2 1 University Medical Center Utrecht, 2 Gelderse Vallei Hospital, Ede, The <strong>Netherlands</strong> Summary. On May 17 TH 2006, a round table conference was held in Ede, the <strong>Netherlands</strong>, to discuss a novel and potentially important accessory treatment for yeast and fungal infections. This novel drug, called Mycograb®, is a human recombinant monoclonal antibody that binds specifically to so-called heat shock protein 90 (HSP90), an immunodominant fungal antigen that appears to play a key role in fungal infections. This mechanism of action is different from all the other currently available “traditional” drug treatments, such as amphotericin-B, fluconazole, voriconazole and caspofungin. Mycograb ® is intended to be used as an additive (combination) treatment with one or more of the “traditional” anti-fungal drugs. It could be combined with any of these “traditional” drugs, and preliminary evidence indicates that it could significantly enhance the performance of these drugs and thus improve outcome, reduce mortality and decrease the time required before a clinical therapeutic response is observed. A panel of eight medical specialists (two chairmen and six invited medical experts with different backgrounds (intensivists, infectiologists, microbiologists and clinical pharmacologists) was invited to discuss this potentially important new development and review the currently available evidence. The meeting was chaired by the authors of this paper, doctors van Zanten and doctor Polderman, and was sponsored by the manufacturer of Mycograb ® , Neutec Pharma plc. NeuTec Pharma was recently acquired by Novartis AG, which thus will be handling the distribution and marketing of Mycograb in the future. Participants P. Donnelly, MD, PhD, medical microbiologist University Medical Center St Radboud, Nijmegen Professor A.R.J. Girbes, internist-intensivist, clinical pharmacologist VU University Medical Center, Amsterdam Professor J. Kesecioglu, MD, PHD, anesthesiologist-intensivist University Medical Center Utrecht P.E. Spronk, MD, PhD, internist-intensivist Gelre hospital, Apeldoorn Dr. E.L. Swart, Pharm MD, Clinical Pharmacologist VU University Medical Center, Amsterdam Professor A.B.J. Groeneveld, MD, PhD, internist-intensivist VU University Medical Center, Amsterdam Chairmen: Kees H. Polderman, MD, PhD, internist-intensivist University Medical Center Utrecht Arthur R.H. van Zanten, MD, internist-intensivist Gelderse Vallei Hospital, Ede Present on behalf of Neutec Pharma, manufacturer of Mycograb Mr. G. Heron Business Development Manager, Neutec Pharma Mr. S. Tague Business Development Manager, Neutec Pharma Correspondence: Kees H. Polderman, MD, Ph.D. E-mail: k.polderman@tip.nl Introduction Infections with various Candida species and, to a lesser extent, Aspergillus infections (Table 1) present a growing problem in intensive care units (ICU’s) throughout the western world. Nosocomial Candida infections can particularly affect patients with prolonged length of stay in the ICU, especially those who have suffered one or more bacterial infections requiring prolonged antibiotic treatment. Other categories at risk include patients undergoing major surgical interventions, especially complicated abdominal surgery. The development of systemic Candida infections, especially Candidaemia or “Candida sepsis” is associated with significant attributable morbidity and mortality, ranging from 5%-15% [1-6]. Yeast infections occur frequently in immune-compromised patients, especially those with haematological malignancies and neutropaenia. However, it would be wrong to assume that the problem is (mainly) limited to this category of patients, or that the Candida infections rarely develop in immune-competent patients. Indeed, critically ill patients in the ICU frequently develop a form of immune suppression known as immunoparalysis [7-10]. Data from the United States National Nosocomial Infection Surveillance (NNIS) system for the years 1990-2002 show that between 5% and 10% of all bloodstream infections in critically ill patients were caused by Candida species [11-14], with similar or even higher rates in the paediatric population [15-16]. In theory this number could be somewhat lower in Europe, because the use of systemic antibiotics is lower compared to the United States. However, data from various European countries suggest that the incidence of Candida infections is comparable. Vincent et al. reported that fungi were responsible for 17.1% of ICU-acquired infections in the European Prevalence of Infection in Intensive Care (EPIC) Study [17]. Geffers and associates studied data from the German Nosocomial Infections Surveillance neth j crit care • volume 10 • no 5 • october 2006 587
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