title: Management of fungal infections in the intensive care unit: a survey of UK practice.
abstract: BACKGROUND
  Candida species are a common cause of nosocomial bloodstream infection. Such infections commonly affect patients in the intensive care unit (ICU) and carry a high mortality. There are published guidelines for the management of fungal infections, but there are no data on the usual management of invasive Candida infections in UK ICUs.
  
  
  METHODS
  An electronic survey was sent by email to a representative clinician in 236 ICUs, over 90% of units in the UK. Questions related to the institution of empirical therapy and to the management of proven candidaemia.
  
  
  RESULTS
  There were 72 responses. A minority of units follow a policy regarding the management of these infections but the involvement of microbiologists is usual. Empirical therapy is used in 85.9% of units, often for patients perceived to be at high risk. Fluconazole is the most commonly used antifungal agent, both for empirical therapy and for the treatment of proven candidaemia. For candidaemic patients, 73.9% of ICUs frequently or always remove central venous catheters within 48 h, while 15.1% frequently or always arrange ophthalmology review.
  
  
  CONCLUSIONS
  Management of fungal infections is relatively consistent among responding units. However, recent developments in the field have not yet been incorporated into standard practice. Adherence to published guidelines could be improved, potentially reducing morbidity and mortality from these common infections.
authors.affiliation: Department of Anaesthesia, Crosshouse Hospital, Kilmarnock KA2 0BE, UK. kitchalmers@doctors.org.uk
authors.forename: C M
authors.initials: CM
authors.lastname: Chalmers
authors.forename: A M
authors.initials: AM
authors.lastname: Bal
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D058387:Candidemia / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy* / Q000635:transmission; D003422:Critical Care / Q000379:methods; D003428:Cross Infection / Q000188:drug therapy*; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D011364:Professional Practice / Q000706:statistics & numerical data; D006113:United Kingdom
chemical_list: D000935:Antifungal Agents