[Fungal infections in intensive care units: a cross-survey].
METHODS
Diagnosis and treatment of fungal infections in medical and surgical intensive care units are controversial issues. The aim of the present survey was to assess the management of fungal infections in these units in France.


METHODS
Transversal study, by means of questionnaires, in a representative sample of French intensive care units, stratified by region and by status of the center.


RESULTS
Eighty-two out of 704 questionnaires were returned (11.6%). The distribution was as follows: academic centers (AC), 52%; local hospitals (LH), 31%; private centers (PC), 17%. In vitro assessment of sensitivity to antifungal drugs was done "sometimes" in 43% of the centers, "always" in 35%. Serologic tests for Candida were performed in 63% of the cases. Antigenemia and PCR testing were nearly never performed. Only 64% of physicians always prescribed an antifungal drug in patients with candidemia (AC > LH = EP, p < 0.05). By contrast, in patients with candiduria and a urinary catheter, a treatment was more frequently thought necessary in LH and EP than in AC (p < 0.05). Empirical treatment was more common in public (70%) than in private (36%) centers (p < 0.05). Increasing doses of amphotericin B, without loading dose, was the generally preferred regimen (55%), and the vehicle was isotonic glucose solution (60%). The mean daily dose of fluconazole was 334 mg, after a mean loading dose of 624 mg. There was no significant differences between the centers.


CONCLUSIONS
Management of fungal infections in intensive care patients appeared to be quite homogeneous, despite some discrepancies between centers about diagnostic procedures and specific indications for antifungal treatment. Attempts should be made to achieve a consensus in the setting of fungal infections.
Dupont
H
H
Département d'anesthésie-réanimation chirurgicale, centre hospitalier universitaire Bichat-Claude Bernard, 46, rue Henri-Huchard, 75018 Paris, France. hdupont@free.fr
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D003625:Data Collection; D015725:Fluconazole / Q000627:therapeutic use; D005437:Flucytosine / Q000627:therapeutic use; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D009181:Mycoses / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D011795:Surveys and Questionnaires
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine