title: [Antifungal treatment for suspected or proved candidiasis in the critically ill].
abstract: OBJECTIVE
  Describe systemic antifungal therapy in non-neutropenic adult patients in intensive care unit (ICU).
  
  
  METHODS
  A prospective, observational study was conducted during the first half of 2010 in the 7 ICU in a hospital with medical consultant on antimicrobial therapy. All non-neutropenic consecutive adult patients receiving systemic antifungal therapy for documented or suspected invasive fungal infection (IFI) apart from aspergillosis were included.
  
  
  RESULTS
  Out of 1502 patients admitted in ICU, 104 (7 %) underwent systemic antifungal therapy, including 30 (29 %) for a documented IFI and 74 (71 %) for a suspected IFI. Candida albicans was identified in 23 (77 %) of the IFI and 45/52 (86 %) of the broncho-pulmonary and/or urinary colonizations in suspected IFI. Echinocandin was significantly more prescribed in patients with a documented infection (19/30 patients) and fluconazole in patients with a suspected infection (48/74 patients). The first line therapy was primarily stopped after recovery (11/30 patients) or de-escalation (9/30 patients) in documented infections, and for lack of indication (34/74 patients) or due to recovery (21/74 patients) in suspected infections after on average of 7 days of treatment.
  
  
  CONCLUSIONS
  For ICU non-neutropenic adult patients in our center, antifungal therapy is prescribed two times out of three for suspected, unproved infections, in most cases with fluconazole. Documented infections were more often treated by echinocandin with secondary de-escalation. An interventional prospective study to assess the role of antifungal pre-emptive or empirical therapy is necessary.
authors.affiliation: Service de réanimation médicale, hôpital Gui-de-Chauliac, centre hospitalier universitaire de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: P
authors.initials: P
authors.lastname: Massanet
authors.affiliation: Département d'anesthésie-réanimation, Inserm U-1046, université Montpellier I, hôpital Saint-Éloi, centre hospitalier universitaire de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France. Electronic address: b-jung@chu-montpellier.fr.
authors.forename: B
authors.initials: B
authors.lastname: Jung
authors.affiliation: Département d'information médicale, hôpital La Colombière, centre hospitalier universitaire de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: N
authors.initials: N
authors.lastname: Molinari
authors.affiliation: Département de pharmacie clinique et dispensation, hôpital Lapeyronie, centre hospitalier universitaire de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: M
authors.initials: M
authors.lastname: Villiet
authors.affiliation: Service de réanimation médicale, hôpital Gui-de-Chauliac, centre hospitalier universitaire de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: V
authors.initials: V
authors.lastname: Moulaire
authors.affiliation: Département de pharmacie clinique et dispensation, hôpital Saint-Éloi, centre hospitalier universitaire de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: I
authors.initials: I
authors.lastname: Roch-Torreilles
authors.affiliation: Département d'anesthésie-réanimation, Inserm U-1046, université Montpellier I, hôpital Saint-Éloi, centre hospitalier universitaire de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: S
authors.initials: S
authors.lastname: Jaber
authors.affiliation: Département des maladies infectieuses et tropicales, hôpital Gui-de-Chauliac, centre hospitalier universitaire de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: J
authors.initials: J
authors.lastname: Reynes
authors.affiliation: Service de réanimation médicale, hôpital Gui-de-Chauliac, centre hospitalier universitaire de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: P
authors.initials: P
authors.lastname: Corne
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002176:Candida albicans; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology; D016638:Critical Illness; D004363:Drug Utilization; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D015725:Fluconazole
keywords: Adult; Adulte; Antifongiques; Antifungal agents; Candida; Candidiasis; Candidose; Intensive care unit; Réanimation