title: Antifungals in the ICU.
abstract: OBJECTIVE
  Invasive fungal infections remain a serious complication for critically ill ICU patients. The aim of this article is to review recent efficacy data of newer antifungal agents for the treatment of invasive candidiasis. The influence that recent epidemiological trends, advances in diagnostic testing, and risk prediction methods exert on the optimization of antifungal therapy for critically ill ICU patients will also be reviewed.
  
  
  RESULTS
  Recent clinical trials have documented the clinical efficacy of the echinocandins and the newer triazoles for the management of invasive candidiasis. Thus far, resistance to echinocandins remains rare. Changes in the epidemiology of Candida spp. causing invasive candidiasis, such as an increasing relative proportion of non-albicans Candida spp., have not been universally reported, although they have important implications for the use of fluconazole as first-line therapy for invasive candidiasis. Efforts to improve the timeliness and accuracy of laboratory diagnostic techniques and clinical prediction models to allow early and accurately targeted antifungal intervention strategies continue.
  
  
  CONCLUSIONS
  Echinocandins, given their clinical efficacy, spectrum of activity, and favourable pharmacological properties, are likely to replace fluconazole as initial antifungal agents of choice among critically ill ICU patients. The optimization of patient outcomes will require more accurately targeted early antifungal intervention strategies based upon sensitive and specific biological and clinical markers of risk.
authors.affiliation: Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia. geoffrey_playford@health.qld.gov.au
authors.forename: Elliott Geoffrey
authors.initials: EG
authors.lastname: Playford
authors.forename: Philippe
authors.initials: P
authors.lastname: Eggimann
authors.forename: Thierry
authors.initials: T
authors.lastname: Calandra
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000145:classification / Q000302:isolation & purification; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016638:Critical Illness; D054714:Echinocandins / Q000627:therapeutic use; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D014230:Triazoles; D015725:Fluconazole