[Invasive candidiasis in ICU: analysis of antifungal treatments in the French study AmarCand].
OBJECTIVE
Comparison of treatments initiated during invasive candidiasis in intensive care units with current French guidelines.


METHODS
Prospective, observational, French multicenter study (October 2005-May 2006).


METHODS
Selection of patients with Candida species identification and in vitro antifungal susceptibility determination. The empiric treatments instituted before the microbiologic documentation of infection and the curative treatments instituted after identification of the causative Candida and determination of its susceptibility were collected and compared with treatments proposed by the French clinical practice guidelines (2004) for the management of patients with invasive candidiasis.


RESULTS
One hundred and eighty-six patients were studied. Invasive candidiasis was due to fluconazole-resistant or susceptible-dose dependent Candida in 18.3% of patients, without any significant influence of a previous treatment with azoles. Empiric and curative treatments were both in accordance with recommendations for 47% of patients. Recommendations were mainly not respected when proposed therapy was amphotericin B that disappeared from therapeutics used in ICU. Finally, 16.9% of episodes of invasive candidiasis, for which fluconazole was the recommended treatment, were due to fluconazole-resistant or susceptible-dose dependent Candida.


CONCLUSIONS
The support of French ICU physicians to current French guidelines was observed in 47% of cases. The infrequent use of amphotericin B must be emphasized. The nonnegligible incidence of fluconazole-resistant or susceptible-dose dependent Candida sp., particularly in patients without any prior exposition to azole agents, and the inability to predict this resistance should lead to propose a revision of 2004 guidelines.
Leroy
O
O
Service de réanimation médicale et des maladies infectieuses, hôpital G.-Chatliez, centre hospitalier Gustave-Dron, 155, rue du Président-Coty, BP 619, 59208 Tourcoing cedex, France. oleroy@ch-tourcoing.fr
Mira
J-P
JP
Montravers
P
P
Gangneux
J-P
JP
Gouin
F
F
Sollet
J-P
JP
Carlet
J
J
Reynes
J
J
Rosenheim
M
M
Régnier
B
B
Lortholary
O
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
D000935:Antifungal Agents