Guidelines for the use of antifungal agents in the treatment of invasive <i>Candida</i> and mould infections

Slavin, Monica A; Szer, Jeffrey; Grigg, Andrew; Roberts, Andrew W.; Seymour, JF; Sasadeusz, Joseph; Thursky, Karin; Chen, S C; Morrissey, C. Orla; Heath, Christopher H.; Sorrell, Tania C.

doi:10.1111/j.1444-0903.2004.00541.x

Cited by 49 publications

(51 citation statements)

References 49 publications

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“…21,28,29 The treatment response of older and newer antifungal agents varies between 60% and 90% ( Table 2).…”

Section: 2829mentioning

confidence: 99%

“…3,5,26,27 For patients who do not have multi-organ failure or severe sepsis, fluconazole may be used for the empirical treatment of candidaemia. 21,28 A broad-spectrum antifungal agent such as amphotericin B or an echinocandin (discussed later) may be used if the patient is haemodynamically unstable or if the patient is known to be colonized with a fluconazole-resistant strain such as Candida krusei.…”

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confidence: 99%

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Management of candidiasis in the intensive care unit

Schelenz

2008

Journal of Antimicrobial Chemotherapy

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In the last two decades, Candida has emerged as an important opportunistic pathogen. Patients admitted to the intensive care unit (ICU) are particularly susceptible to this infection because of the severity of their underlying illness and the excess use of medical and surgical interventions. The frequent use of antibiotics, central venous catheters and other intravascular devices as well as poor gut motility or abdominal surgery place these patients at high risk of infection, which contributes to the morbidity and mortality of the already critically ill patient. Early recognition and appropriate management of invasive candidiasis are therefore important. This article addresses important management issues such as the role of screening for Candida colonization, the use of prophylaxis and the choice of antifungal agents for the treatment of presumed and proven invasive candidiasis in the adult ICU setting.

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“…21,28,29 The treatment response of older and newer antifungal agents varies between 60% and 90% ( Table 2).…”

Section: 2829mentioning

confidence: 99%

mentioning

confidence: 99%

Management of candidiasis in the intensive care unit

Schelenz

2008

Journal of Antimicrobial Chemotherapy

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“…Forty-one per cent (16/39) of respondents commenced prophylaxis on admission, while 44% (17/39) aligned the start of prophylaxis with the start of chemotherapy. Forty-three per cent of respondents (10/23) ceased prophylaxis upon resolution of neutropenia (neutrophil counts at least >500 cells/mm 3 ). Most respondents (79%; 30/38) also preferred posaconazole for prophylaxis during consolidation chemotherapy with the timing of commencement and cessation similar to induction.…”

Section: Acute Myeloid Leukaemiamentioning

confidence: 99%

“…During maintenance chemotherapy for ALL, 34% (11/33) of respondents used no prophylaxis, while 52% (17/33) used fluconazole prophylaxis. Irrespective of cycle of chemotherapy, most respondents initiated prophylaxis around the commencement of chemotherapy and ceased prophylaxis upon resolution of neutropenia (neutrophil counts at least >500 cells/mm 3 ).…”

Section: Acute Lymphocytic Leukaemiamentioning

confidence: 99%

Survey of antifungal prophylaxis and fungal diagnostic tests employed in malignant haematology and haemopoietic stem cell transplantation (HSCT) inAustralia andNewZealand

Hal

Gilroy

Morrissey

et al. 2014

Internal Medicine Journal

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This article reports the findings of a survey developed to assess the current use of antifungal prophylaxis among haematology and infectious disease clinicians across Australia and New Zealand, and their alignment with existing consensus guidelines for the use of antifungal agents in the haematology/oncology setting (published 2008). Surveyed clinicians largely followed the current recommendations for prophylaxis in the setting of induction chemotherapy for acute myeloid leukaemia, as well as autologous and low-risk allogeneic haemopoietic stem cell transplantation (HSCT). In keeping with guideline recommendations, posaconazole was the agent used by most centres for high-risk allogeneic HSCT. However, its routine continuation for 75-100 days posttransplantation without de-escalation suggested use beyond those indications described in the 2008 guidelines, namely pre-engraftment neutropenia and graft-versus-host disease. Variations in practice were observed in other settings, such as acute lymphoblastic leukaemia and myelodysplastic syndrome, reflecting the general lack of evidence for antifungal prophylaxis in these patient populations and changing perceptions of risk. With regard to the availability of testing in cases of suspected breakthrough IFD, 40% of centres did not have access to investigative bronchoscopy within 48 h of referral, and results of Aspergillus galactomannan (GM), fungal polymerase chain reaction and therapeutic drug monitoring (TDM) were not available within 48 h in 83%, 90% and 85% of centres respectively. The survey's findings will influence the recommendations provided in the updated 2014 consensus guidelines for the use of antifungal agents in the haematology/oncology setting.

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“…In view of the different drug resistance profiles of many clinically relevant fungal pathogens (34), the development of rapid methods for species-specific identification of clinically important fungi is desirable in order to permit selection of the most appropriate antifungal treatment. Traditional diagnostic approaches to the identification of fungal species are mainly based on phenotype analysis of fungal cultures.…”

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Species-Specific Identification of a Wide Range of Clinically Relevant Fungal Pathogens by Use of Luminex xMAP Technology

et al. 2009

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In immunocompromised patients suffering from invasive fungal infection, rapid identification of the fungal species is a prerequisite for selection of the most appropriate antifungal treatment. We present an assay permitting reliable identification of a wide range of clinically relevant fungal pathogens based on the highthroughput Luminex microbead hybridization technology. The internal transcribed spacer (ITS2) region, which is highly variable among genomes of individual fungal species, was used to generate oligonucleotide hybridization probes for specific identification. The spectrum of pathogenic fungi covered by the assay includes the most commonly occurring species of the genera Aspergillus and Candida and a number of important emerging fungi, such as Cryptococcus, Fusarium, Trichosporon, Mucor, Rhizopus, Penicillium, Absidia, and Acremonium. Up to three different probes are employed for the detection of each fungal species. The redundancy in the design of the assay should ensure unambiguous fungus identification even in the presence of mutations in individual target regions. The current set of hybridization oligonucleotides includes 75 speciesand genus-specific probes which had been carefully tested for specificity by repeated analysis of multiple reference strains. To provide adequate sensitivity for clinical application, the assay includes amplification of the ITS2 region by a seminested PCR approach prior to hybridization of the amplicons to the probe panel using the Luminex technology. A variety of fungal pathogens were successfully identified in clinical specimens that included peripheral blood, samples from biopsies of pulmonary infiltrations, and bronchotracheal secretions derived from patients with documented invasive fungal infections. Our observations demonstrate that the Luminex-based technology presented permits rapid and reliable identification of fungal species and may therefore be instrumental in routine clinical diagnostics.Although the vast majority of invasive fungal infections are still caused by Aspergillus or Candida species, changes in epidemiology have become evident over the last years (11,15,33,39). In view of the different drug resistance profiles of many clinically relevant fungal pathogens (34), the development of rapid methods for species-specific identification of clinically important fungi is desirable in order to permit selection of the most appropriate antifungal treatment. Traditional diagnostic approaches to the identification of fungal species are mainly based on phenotype analysis of fungal cultures. However, these approaches are time-consuming and show limited applicability for the detection of molds (29). Over the last years, a variety of molecular methods have been established for rapid and sensitive detection of fungal pathogens. Many of these assays are real-time quantitative PCR tests, mostly targeting the ribosomal multicopy gene (rDNA gene) (1, 3, 12-14, 16, 21, 30, 31, 35, 40). With these techniques, the fungal sequences of interest can be amplified by universa...

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Guidelines for the use of antifungal agents in the treatment of invasive Candida and mould infections

Cited by 49 publications

References 49 publications

Management of candidiasis in the intensive care unit

Management of candidiasis in the intensive care unit

Survey of antifungal prophylaxis and fungal diagnostic tests employed in malignant haematology and haemopoietic stem cell transplantation (HSCT) inAustralia andNewZealand

Species-Specific Identification of a Wide Range of Clinically Relevant Fungal Pathogens by Use of Luminex xMAP Technology

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