Invasive candidiasis: comparison of management choices by infectious disease and critical care specialists.
OBJECTIVE
To compare the management of invasive candidiasis between infectious disease and critical care specialists.


METHODS
Clinical case scenarios of invasive candidiasis were presented during interactive sessions at national specialty meetings. Participants responded to questions using an anonymous electronic voting system.


METHODS
Sixty-five infectious disease and 51 critical care physicians in Switzerland.


RESULTS
Critical care specialists were more likely to ask advice from a colleague with expertise in the field of fungal infections to treat Candida glabrata (19.5% vs. 3.5%) and C. krusei (36.4% vs. 3.3%) candidemia. Most participants reported that they would change or remove a central venous catheter in the presence of candidemia, but 77.1% of critical care specialists would start concomitant antifungal treatment, compared to only 50% of infectious disease specialists. Similarly, more critical care specialists would start antifungal prophylaxis when Candida spp. are isolated from the peritoneal fluid at time of surgery for peritonitis resulting from bowel perforation (22.2% vs. 7.2%). The two groups equally considered Candida spp. as pathogens in tertiary peritonitis, but critical care specialists would more frequently use amphotericin B than fluconazole, caspofungin, or voriconazole. In mechanically ventilated patients the isolation of 10(4) Candida spp. from a bronchoalveolar lavage was considered a colonizing organism by 94.9% of infectious disease, compared to 46.8% of critical care specialists, with a marked difference in the use of antifungal agents (5.1% vs. 51%).


CONCLUSIONS
These data highlight differences between management approaches for candidiasis in two groups of specialists, particularly in the reported use of antifungals.
Eggimann
Philippe
P
Infection Control Program, University of Geneva Hospitals, 24 Rue Micheli-du-Crest, 1211, Geneva 14, Switzerland.
Calandra
Thierry
T
Fluckiger
Ursula
U
Bille
Jacques
J
Garbino
Jorge
J
Glauser
Michel-Pierre
MP
Marchetti
Oscar
O
Ruef
Christian
C
Täuber
Martin
M
Pittet
Didier
D
D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002177:Candidiasis / Q000188:drug therapy / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D011183:Postoperative Complications; D012121:Respiration, Artificial / Q000009:adverse effects; D013038:Specialization
D000935:Antifungal Agents