Fungal infection in surgical patients.
Invasive fungal infections have become a major source of morbidity and mortality in the modern surgical intensive care unit. Patients at risk for invasion and dissemination are common, and are not as ill as thought previously. Severity of illness (APACHE II score > 10, ventilator use for >48 hours), antibiotics, central venous lines, total parenteral nutrition, burns, and immunosuppression are the most common risk factors. Recognition of these risk factors should arouse a high index of suspicion for the diagnosis of invasion or dissemination. Unfortunately, laboratory tests alone lack sensitivity and specificity. Therefore, the diagnosis of invasion and dissemination in the majority of cases requires the acquisition and proper interpretation of clinical evidence. Once the diagnosis is made, early systemic treatment is warranted. Reported toxicity and efficacy supports the use of fluconazole for most patients with invasive fungal infections. However, for the most critically ill patients amphotericin B remains the treatment of choice.
Dean
D A
DA
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA.
Burchard
K W
KW
D000935:Antifungal Agents / Q000627:therapeutic use; D002056:Burns / Q000150:complications; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects; D006801:Humans; D007108:Immune Tolerance; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012307:Risk Factors
D000935:Antifungal Agents