Invasive fungal infections in critically ill patients: different therapeutic options and a uniform strategy.
The high morbidity, mortality, and healthcare costs associated with the invasive fungal infections, especially in the critical care setting, is of importance since the prophylactic, empiric, and pre-emptive therapy interventions, based on early identification of risk factors, is of common occurrence. In the last years alone there have been important developments in antifungal pharmacotherapy. Evidence-based studies using new antifungal agents are now emerging as important players in the pharmacotherapy of invasive fungal infections in seriously ill and difficult patients. However, data on critically ill patients are more limited and usually recovered from general studies. This study shows the benefits obtained by the new antifungal agents on different clinical situations in critical care units. The increasing number of non-C. albicans species and the high mortality rates in these settings suggest that the application of early de-escalation therapy in critically ill patients with fungal infection should be mandatory. The possibility of using antifungal combination therapy in these types of patients should be considered.
Zaragoza
Rafael
R
Intensive Care Unit, Hospital Universitario Peset, Av. Gaspar Aguilar 90, 46017 Valencia, Spain. zaragoza_raf@gva.es
Pemán
Javier
J
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy; D003840:Deoxycholic Acid / Q000627:therapeutic use; D004338:Drug Combinations; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D009181:Mycoses / Q000188:drug therapy* / Q000517:prevention & control; D011743:Pyrimidines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D004338:Drug Combinations; D011743:Pyrimidines; D014230:Triazoles; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D015725:Fluconazole; D065819:Voriconazole