Invasive candidiasis in critical care setting, updated recommendations from “Invasive Fungal Infections-Clinical Forum”, Iran

Abstract

Invasive candidiasis (IC) bears a high risk of morbidity and mortality in the intensive care units (ICU). With the current advances in critical care and the use of widespectrum antibiotics, invasive fungal infections (IFIs) and IC in particular, have turned into a growing concern in the ICU. Further to blood cultures, some auxil- REVIEW 102November 4, 2014|Volume 3|Issue 4| WJCCM|www.wjgnet.com iary laboratory tests and biomarkers are developed to enable an earlier detection of infection, however these test are neither consistently available nor validated in our setting. On the other hand, patients' clinical status and local epidemiology data may justify the empiric antifungal approach using the proper antifungal option. The clinical approach to the management of IC in febrile, non-neutropenic critically ill patients has been defined in available international guidelines; nevertheless such recommendations need to be customized when applied to our local practice. Over the past three years, Iranian experts from intensive care and infectious diseases disciplines have tried to draw a consensus on the management of IFI with a particular focus on IC in the ICU. The established IFI-clinical forum (IFI-CF), comprising the scientific leaders in the field, has recently come up with and updated recommendation on the same (June 2014). The purpose of this review is to put together literature insights and Iranian experts' opinion at the IFI-CF, to propose an updated practical overview on recommended approaches for the management of IC in the ICU. Core tip: The present consensus statement has attempted to summarize the practical highlights regarding the management of Invasive Candidiasis (IC) in critical care setting. This easy-to-follow clinical pathway is expected to be not only of interest but also of clinical use for those who deal with the management of invasive fungal infections in hospital setting and especially the intensive care units. The focus of this paper is the concept of timely management of IC in critically ill patients.

Antifungal agents for invasive candidiasis in non-neutropenic critically ill adults: What do the guidelines recommend?

“…We identified 7230 relevant titles and selected 19 CPGs for inclusion ( Figure 1) (Aguado et al, 2011, Alothman et al, 2014, Bassetti et al, 2013, Bow et al, 2010, Chen et al, 2014, Colombo et al, 2013, Cornely et al, 2012, Elhoufi et al, 2014, JSMM, 2013, Kohno et al, 2016, Kung et al, 2018, Limper et al, 2011, Luo et al, 2014, Montravers et al, 2015, Pappas et al, 2016, Ruhnke et al, 2011, Scudeller et al, 2016, Scudeller et al, 2014, Zaragoza et al, 2014. Table 1 presents the main characteristics of included CPGs.…”

“…A specific drug was mentioned in seven of the ten guidelines that described prophylaxis: fluconazole was recommended as the initial drug of choice in all seven CPGs (Aguado et al, 2011, Bassetti et al, 2013, Bow et al, 2010, Cornely et al, 2012, Elhoufi et al, 2014, Luo et al, 2014, Pappas et al, 2016. Echinocandin was mentioned as an acceptable alternative in only two CPGs (Bassetti et al, 2013, Pappas et al, 2016.…”

“…burn patients who have received two different broad spectrum antibiotics for a minimum of five days) (Luo et al, 2014). With the exception of the ESCMID guideline (Cornely et al, 2012), echinocandins were recommended as the initial drug in all 16 CPGs that supported empirical or pre-emptive treatment (Alothman et al, 2014, Bassetti et al, 2013, Bow et al, 2010, Chen et al, 2014, Colombo et al, 2013, Elhoufi et al, 2014, JSMM, 2013, Kohno et al, 2016, Kung et al, 2018, Luo et al, 2014, Montravers et al, 2015, Pappas et al, 2016, Ruhnke et al, 2011, Scudeller et al, 2016, Scudeller et al, 2014, Zaragoza et al, 2014. Fluconazole and liposomal amphotericin B (L-AMB) were listed as other initial agents in six (Bow et al, 2010, Elhoufi et al, 2014, JSMM, 2013, Kohno et al, 2016, Kung et al, 2018, Montravers et al, 2015 and two (Bassetti et al, 2013, Ruhnke et al, 2011 CPGs, respectively.…”

“…With the exception of the ESCMID guideline (Cornely et al, 2012), echinocandins were recommended as the initial drug in all 16 CPGs that supported empirical or pre-emptive treatment (Alothman et al, 2014, Bassetti et al, 2013, Bow et al, 2010, Chen et al, 2014, Colombo et al, 2013, Elhoufi et al, 2014, JSMM, 2013, Kohno et al, 2016, Kung et al, 2018, Luo et al, 2014, Montravers et al, 2015, Pappas et al, 2016, Ruhnke et al, 2011, Scudeller et al, 2016, Scudeller et al, 2014, Zaragoza et al, 2014. Fluconazole and liposomal amphotericin B (L-AMB) were listed as other initial agents in six (Bow et al, 2010, Elhoufi et al, 2014, JSMM, 2013, Kohno et al, 2016, Kung et al, 2018, Montravers et al, 2015 and two (Bassetti et al, 2013, Ruhnke et al, 2011 CPGs, respectively. Fluconazole was recommended as an appropriate alternative drug in five CPGs (Alothman et al, 2014, Bassetti et al, 2013, Colombo et al, 2013, Pappas et al, 2016, Scudeller et al, 2014, L-AMB in seven (Alothman et al, 2014, Chen et al, 2014, Colombo et al, 2013, JSMM, 2013, Pappas et al, 2016, Scudeller et al, 2016…”

TNF-α Production Modulated by Aloe Vera Gel Extract and its Fractions in Candida Albicans Infected Macrophages

“…Candida species are common causes of nosocomial infections, with an incidence that has significantly increased in the recent years. It has been reported that Candida is responsible for 9% of all nosocomial bloodstream infections and it is the most common cause of invasive mycoses [3][4][5]. Its crude mortality rate ranges from 40% to 60% and it is ranked as the fourth opportunist infectious agent after Staphylococcus aureus, Pseudomonas Spp, and Escherichia coli in hospitals [4,[6][7][8].…”