title: [Invasive fungal infection in critically ill patients].
abstract: The most common organism implicated in fungal infections in the critically ill patients is Candida spp. C. albicans continues to be the species that causes the largest number of invasive candidiasis. In critically ill patients, Candida spp. are frequently isolated in non-sterile sites. Candida colonization is documented in nearly 60% of non-neutropenic critically ill patients staying more than one week in the ICU. However, only 5% of colonized patients will develop invasive candidiasis. The diagnosis of invasive non-candidemic candidiasis remains elusive in the majority of the patients. Candida in a blood culture should never be viewed as a contaminant and should always prompt treatment initiation. Patients with multifocal colonization with a Candida score >3 should also receive antifungal therapy. Fluconazole is reserved for non-severely ill patients without recent exposure to azoles. The use of an echinocandin is recommended for hemodynamically unstable patients or with a history of recent fluconazole exposure.
authors.affiliation: Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España. jose.garnacho.sspa@juntadeandalucia.es
authors.forename: José
authors.initials: J
authors.lastname: Garnacho-Montero
authors.forename: Ana
authors.initials: A
authors.lastname: Díaz-Martín
authors.forename: Maite
authors.initials: M
authors.lastname: Ruiz-Pérez De Piappón
authors.forename: Emilio
authors.initials: E
authors.lastname: García-Cabrera
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D058365:Candidiasis, Invasive / Q000188:drug therapy / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002986:Clinical Trials as Topic; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007121:Immunocompetence; D007362:Intensive Care Units; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D009894:Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000382:microbiology; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000382:microbiology / Q000635:transmission
chemical_list: D000935:Antifungal Agents