Management of Candida species infections in critically ill patients.
Invasive candidiasis is a feared infection with mortality similar to that of septic shock (40-60%). Improved knowledge of its pathophysiology and the availability of new compounds for antifungal therapy and prophylaxis have contributed to improving the prognosis of severe candidal infections among immunosuppressed patients at the possible cost of the emergence of non-albicans strains of candida with lower susceptibility to azoles. This review focuses on the management of invasive deep-seated candidiasis in critically ill, non-immunocompromised patients. We discuss antifungal use, indications, potential benefit, and main secondary effects. Prevention strategies include pre-emptive antifungal therapy and azole-based prophylaxis. For patients at lower initial risk, pre-emptive therapy should be based on a management strategy that takes into account the presence of definite risk factors and the dynamics of candida colonisation. Among critically ill patients, azole prophylaxis is effective and is not associated with acquisition of resistance; it must be restricted to highly selected groups of patients at high risk only.
Eggimann
Philippe
P
Medical Clinic II and Intensive Care Unit, and the Infection Control Programme, Department of Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland.
Garbino
Jorge
J
Pittet
Didier
D
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D001393:Azoles / Q000627:therapeutic use; D002177:Candidiasis / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D016638:Critical Illness; D006801:Humans; D007121:Immunocompetence; D009761:Nystatin / Q000627:therapeutic use; D017410:Practice Guidelines as Topic
D000935:Antifungal Agents; D001393:Azoles; D009761:Nystatin; D000666:Amphotericin B