Diagnosis of invasive candidiasis in the ICU

Abstract

Invasive candidiasis ranges from 5 to 10 cases per 1,000 ICU admissions and represents 5% to 10% of all ICU-acquired infections, with an overall mortality comparable to that of severe sepsis/septic shock. A large majority of them are due to Candida albicans, but the proportion of strains with decreased sensitivity or resistance to fluconazole is increasingly reported. A high proportion of ICU patients become colonized, but only 5% to 30% of them develop an invasive infection. Progressive colonization and major abdominal surgery are common risk factors, but invasive candidiasis is difficult to predict and early diagnosis remains a major challenge. Indeed, blood cultures are positive in a minority of cases and often late in the course of infection. New nonculture-based laboratory techniques may contribute to early diagnosis and management of invasive candidiasis. Both serologic (mannan, antimannan, and betaglucan) and molecular (Candida-specific PCR in blood and serum) have been applied as serial screening procedures in high-risk patients. However, although reasonably sensitive and specific, these techniques are largely investigational and their clinical usefulness remains to be established. Identification of patients susceptible to benefit from empirical antifungal treatment remains challenging, but it is mandatory to avoid antifungal overuse in critically ill patients. Growing evidence suggests that monitoring the dynamic of Candida colonization in surgical patients and prediction rules based on combined risk factors may be used to identify ICU patients at high risk of invasive candidiasis susceptible to benefit from prophylaxis or preemptive antifungal treatment.

Karakteristik Klinis dan Prevalensi Pasien Kandidiasis Invasif di Rumah Sakit Cipto Mangunkusumo

“…Antibiotik spektrum luas ini akan menekan pertumbuhan bakteri-bakteri yang ada di tubuh, mengganggu keseimbangan mikroorganisme, sehingga akan terjadi peningkatan kolonisasi Candida yang akan meningkatkan risiko terjadinya kandidiasis invasif. 15 Piranti medis yang paling sering digunakan dalam penelitian ini adalah kateter uretra, selang nasogastrik, dan nutrisi parenteral. Hal tersebut serupa dengan studi yang dilakukan oleh Xie, dkk.…”

Value of β-d-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions

“…The diagnosis of invasive candidiasis (IC) in patients admitted to the ICU still poses a challenge [1]. Clinical prediction rules are relevant elements enabling proper diagnosis but some of them are not easy to fulfill, have not been previously validated, or may be eventually unhelpful in patients having abdominal surgery (e.g., the Candida score) [2][3][4][5].…”

A study on rapid diagnosis (by PCR) and cost-effective treatment of pulmonary mycosis

“…3 The rising rate of fungal infections in critically ill patients is mainly due to impairment of host defense mechanisms as a consequence of immunodeficiency caused by viral infections, haematological disorders, organ transplantation and more invasive and aggressive medical treatment protocols such as surgeries, use of catheters, radiation, chemotherapy, use of steroids and the indiscriminate use of broad spectrum antibiotics causing change in endogenous/commensal flora. 4,5 Among etiological agents, Candida species and Aspergillus species are by far the most common causes of invasive fungal infections in critically ill patients, although recently a shift has been witnessed towards other non-albicans Candida species. Moreover, other yeasts and moulds, such as Zygomycetes, Cryptococcus, Fusarium and Scedosporium have also been recognized as emerging pathogens in recent years.…”