[Update: invasive fungal infections: Diagnosis and treatment in surgical intensive care medicine].
Fungal infections are of great relevance in surgical intensive care and Candida species represent the predominant part of fungal pathogens. Invasive aspergillosis is also relevant especially in patients with chronic pulmonary diseases. It is crucial for therapy success to begin adequate antifungal treatment at an early stage of the disease. Risk stratification of individual patient symptoms is essential for therapy timing. In case of suspected or proven candida infection, fluconazole is the agent of choice when the patient is clinically stable and no azoles have been administrated in advance and the local epidemiology makes azol resistance unlikely. For clinically instable patients with organ dysfunction the echinocandins serve as primary therapy because of their broad spectrum and reasonable safety profile. Due to a relevant proportion of azole resistant Candida species, susceptibility testing should be done routinely. Depending on the species detected de-escalating to an azole is feasible if organ dysfunctions have resolved. An invasive aspergillosis is primarily treated with voriconazole.
Lichtenstern
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Klinik für Anaesthesiologie und Operative Intensivmedizin, Universitätsklinikum Giessen und Marburg, Standort Giessen, Germany. christoph.lichtenstern@chiru.med.uni-giessen.de
Swoboda
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S
Hirschburger
M
M
Domann
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E
Hoppe-Tichy
T
T
Winkler
M
M
Lass-Flörl
C
C
Weigand
M A
MA
D000276:Adjuvants, Immunologic / Q000378:metabolism; D000935:Antifungal Agents / Q000627:therapeutic use; D001393:Azoles / Q000627:therapeutic use; D002177:Candidiasis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy / Q000652:urine; D003422:Critical Care; D003453:Cryptococcosis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D054714:Echinocandins / Q000627:therapeutic use; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D008351:Mannans; D009093:Mucus / Q000382:microbiology; D009181:Mycoses / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy* / Q000652:urine*; D011090:Polyenes / Q000627:therapeutic use; D020133:Reverse Transcriptase Polymerase Chain Reaction; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D047071:beta-Glucans / Q000378:metabolism
D000276:Adjuvants, Immunologic; D000935:Antifungal Agents; D001393:Azoles; D054714:Echinocandins; D008351:Mannans; D011090:Polyenes; D047071:beta-Glucans; C012990:galactomannan; C033363:beta-1,3-glucan; D005690:Galactose