title: Candidemia and invasive candidiasis: a review of the literature for the burns surgeon.
abstract: Advances in critical care, operative techniques, early fluid resuscitation, antimicrobials to control bacterial infections, nutritional support to manage the hypermetabolic response and early wound excision and coverage has improved survival rates in major burns patients. These advances in management have been associated with increased recognition of invasive infections caused by Candida species in critically ill burns patients. Candida albicans is the most common species to cause invasive Candida infections, however, non-albicans Candida species appear to becoming more frequent. These later species may be less fluconazole susceptible than Candida albicans. High crude and attributable mortality rates from invasive Candida sepsis are multi-factorial. Diagnosis of invasive candidiasis and candidemia remains difficult. Prophylactic and pre-emptive therapies appear promising strategies, but there is no specific approach which is well-studied and clearly efficacious in high-risk burns patients. Treatment options for invasive candidiasis include several amphotericin B formulations and newer less toxic antifungal agents, such as azoles and echinocandins. We review the currently available data on diagnostic and management strategies for invasive candidiasis and candidemia; whenever possible providing reference to the high-risk burn patients. We also present an algorithm for the management of candidemia and invasive candidiasis in burn patients.
authors.affiliation: Telstra Burns Unit, Department of Plastic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia. jenha81@yahoo.com.au
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Ha
authors.forename: Claire M
authors.initials: CM
authors.lastname: Italiano
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Heath
authors.forename: Sophia
authors.initials: S
authors.lastname: Shih
authors.forename: Suzanne
authors.initials: S
authors.lastname: Rea
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Wood
mesh_terms: D000465:Algorithms; D000935:Antifungal Agents / Q000627:therapeutic use*; D002056:Burns / Q000150:complications* / Q000382:microbiology; D058387:Candidemia / Q000188:drug therapy; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D016469:Fungemia / Q000188:drug therapy*; D006801:Humans; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents