Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part II. Treatment.
BACKGROUND
Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting particularly in the intensive care unit (ICU).


OBJECTIVE
To review the current management of invasive candidiasis and candidemia in non-neutropenic adult ICU patients based on a review of the literature and an European expert panel discussion.


CONCLUSIONS
Empiric and directed treatment for invasive candidiasis are predicated on the hemodynamic status of the patient. Unstable patients may benefit from broad-spectrum antifungal agents, which can be narrowed once the patient has stabilized and the identity of the infecting species is established. In stable patients, a more classical approach using fluconazole may be satisfactory provided that the patient is not colonized with fluconazole resistant strains or there has been recent past exposure to an azole (<30 days). In contrast, pre-emptive therapy is based on the presence of surrogate markers.
Guery
Benoît P
BP
Infectious Diseases, SGRIVI, Hopital Huriez, CHRU Lille, 59045, Lille Cedex, France.
Arendrup
Maiken C
MC
Auzinger
Georg
G
Azoulay
Elie
E
Borges Sá
Márcio
M
Johnson
Elizabeth M
EM
Müller
Eckhard
E
Putensen
Christian
C
Rotstein
Coleman
C
Sganga
Gabriele
G
Venditti
Mario
M
Zaragoza Crespo
Rafael
R
Kullberg
Bart Jan
BJ
D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000097:blood* / Q000382:microbiology*; D002176:Candida albicans / Q000302:isolation & purification*; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology*; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole