title: [Antifungal treatments of candidemia in non-neutropenic patients: evaluation of practice in intensive care units].
abstract: OBJECTIVE
  The authors had for objective to assess systemic antifungal treatment for candidemia in non-neutropenic patients, in intensive care units (ICU), and compare the results with French 2004 recommendations.
  
  
  METHODS
  A retrospective multicenter study (nine ICU in two teaching hospitals) was made.
  
  
  METHODS
  Thirty-eight non-neutropenic patients with at least one positive blood culture for Candida who had received systemic antifungal treatment were included between May 2004 and September 2007.
  
  
  RESULTS
  Thirty-nine cases of candidemia were analyzed. The median age was 54.5 (21-80), the median SAPS II score at admission was 44 (20-79), the median duration of stay in ICU was 22.5 days (2-82), and the death rate was 45%. Candida albicans was identified in 69% of the cases. Eight percent of Candida sp. isolates were resistant or susceptible dose-dependent (S-DD) to fluconazole. Before identification, fluconazole, caspofungin, voriconazole, and amphotericin B were used in 74%, 15%, 5%, and 5% of cases respectively. After identification and antifungal susceptibility determination, fluconazole was used in 68% of cases, caspofungin in 24% of cases, any formulation of amphotericin B in 6% of cases, voriconazole in 3% of cases. The French recommendations were applied in 71% of cases before identification and in 68% of cases after identification and antifungal susceptibility determination.
  
  
  CONCLUSIONS
  The main causes of non-compliance to recommendations were the use of fluconazole in patients previously exposed to azole agents, the use of caspofungin in hemodynamically unstable patients, and the absence of therapeutic desescalade.
authors.affiliation: Service de réanimation médicale-assistance respiratoire, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: P
authors.initials: P
authors.lastname: Massanet
authors.forename: P
authors.initials: P
authors.lastname: Corne
authors.forename: M
authors.initials: M
authors.lastname: Conseil
authors.forename: P-F
authors.initials: PF
authors.lastname: Perrigault
authors.forename: L
authors.initials: L
authors.lastname: Lachaud
authors.forename: S
authors.initials: S
authors.lastname: Jaber
authors.forename: B
authors.initials: B
authors.lastname: Calvet
authors.forename: O
authors.initials: O
authors.lastname: Jonquet
authors.forename: J
authors.initials: J
authors.lastname: Reynes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D058387:Candidemia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000935:Antifungal Agents