Is Candida really a threat in the ICU?
OBJECTIVE
The epidemiological and clinical relevance of Candida in the ICU is reviewed. Three issues were appraised. First is the prevalence of Candida. Second is the relevance of nonblood cultures positive for Candida and multisite colonization. Third is the importance of invasive candidiasis in terms of mortality.


RESULTS
The diagnosis of invasive candidiasis remains problematic in nonblood cultures. Consequently, the true prevalence of invasive candidiasis is difficult to assess. Another result of the complicated diagnosis is the risk for delayed antifungal therapy in case of systemic Candida infection. Therefore, pre-emptive therapy has become increasingly popular in high-risk patients.


CONCLUSIONS
Candida spp. cause a minority of nosocomial bloodstream infections ( approximately 4-9%). Yet, delayed initiation of appropriate antifungal therapy results in significant attributable mortality. Given the inability to efficiently discriminate colonization from invasive candidiasis, this is a problematic issue. The presence of Candida in tracheal aspirates, urine cultures or wound swabs frequently reflects colonization. Yet, multisite colonization frequently precedes systemic invasion. As such, multisite Candida colonization is a crucial element in the decision to start pre-emptive therapy. However, the predictive value of multisite colonization in the absence of an overt risk profile for invasive candidiasis appears to be low.
Blot
Stijn
S
General Internal Medicine and Infectious Diseases, Ghent University Hospital, Belgium. stijn.blot@UGent.be
Dimopoulos
George
G
Rello
Jordi
J
Vogelaers
Dirk
D
D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification / Q000472:pathogenicity*; D002177:Candidiasis / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D003428:Cross Infection / Q000382:microbiology; D046508:Culture Techniques; D006801:Humans; D007362:Intensive Care Units; D014481:United States / Q000453:epidemiology
D000935:Antifungal Agents