title: Diagnosing invasive fungal disease in critically ill patients.
abstract: Fungal infections are increasing, with a changing landscape of pathogens and emergence of new groups at risk for invasive disease. We review current diagnostic techniques, focusing on studies in critically ill patients. Microbiological cultures, the current "gold standard", demonstrate poor sensitivity, thus diagnosis of invasive disease in the critically ill is difficult. This diagnostic dilemma results in under- or over-treatment of patients, potentially contributing to poor outcomes and antifungal resistance. While other current diagnostic tests perform moderately well, many lack timeliness, efficacy, and are negatively affected by treatments common to critically ill patients. New nucleic acid-based research is promising.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Joe L
authors.initials: JL
authors.lastname: Hsu
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ruoss
authors.forename: Natalie D
authors.initials: ND
authors.lastname: Bower
authors.forename: Margaret
authors.initials: M
authors.lastname: Lin
authors.forename: Mark
authors.initials: M
authors.lastname: Holodniy
authors.forename: David A
authors.initials: DA
authors.lastname: Stevens
mesh_terms: D016638:Critical Illness; D006801:Humans; D007362:Intensive Care Units; D009172:Mycology / Q000379:methods*; D009181:Mycoses / Q000175:diagnosis*