Increasing fungal infections in the intensive care unit.
BACKGROUND
Yeasts and molds now rank among the most common pathogens in intensive care units. Whereas the incidence of Candida infections peaked in the late 1970s, aspergillosis is still increasing.


METHODS
Review of the pertinent English-language literature.


RESULTS
Most factors promoting an invasive fungal infection are difficult to avoid because they are connected directly to treatment of the underlying disease. Antifungal treatment is often commenced on an empiric basis, whereas it might be preferable to adopt a strategy based on a diagnostic procedure able to demonstrate or exclude fungal disease. Polyenes have been the drugs of choice, but voriconazole is the new standard for aspergillosis. For invasive candidiasis, fluconazole is a more convenient option, with the new echinocandins or voriconazole as alternatives.


CONCLUSIONS
The incidence of invasive fungal infection is increasing, but so too are the choices of agents for therapy. For reasons of efficacy and safety, therapy with an echinocandin or azole antifungal agent is supplanting the use of polyenes.
De Pauw
Ben E
BE
Department of Blood Transfusion Service and Transplant Immunology, University Medical Center St. Radboud, Nijmegen, The Netherlands. b.depauw@abti.umcn.n
D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D009181:Mycoses / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology
D000935:Antifungal Agents