Management of candidiasis in the intensive care unit

Abstract

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.

Candida spp. isolated from inpatients, the environment, and health practitioners in the pediatric unit at the Universitary Hospital of the Jundiaí Medical College, state of São Paulo, Brazil

“…However, there is a new therapeutic class of antifungal drugs for invasive candidiasis. This class is known as the echinocandins, which are showing to be more safe and effective and with fewer side effects than the other drugs; they can be used as an excellent therapeutic option, especially in cases of recent history of exposure to an azole, moderately severe to severe illness (i.e., hemodynamically unstable), and allergy or intolerance to azoles [66][67][68][69][70][71] . Although amphotericin B remains a therapeutic option because of its broad spectrum and low cost, it produces side effects related to infusion and nephrotoxicity [71][72][73] .…”

Genetic Differentiation of Fungi of the Genus Candida Isolated from Patients with Inflammatory Bowel Diseases

“…The development of medicine and the introduction of new therapeutic strategies paradoxically contribute to the increase of fungal inflammations. It is mostly connected with an increasing number of patients with immunosuppression and disturbed homeostasis (Schelenz, 2008).…”

“…Other diseases causing inflammations are: diabetes and other endocrinopathies, infections due to HIV virus and also surgical procedures, damaged tissues and inflammations of the mucous membrane of the alimentary tract. Aggressive therapies with antibiotics, steroids and immunosuppressants disturb the endogenic bacterial flora and as a result contribute to the development of mycoses (Budak et al, 2003;Schelenz, 2008). The most essential factors affecting the increase of the frequency of fungal infections, especially those with Candida etiology, are commonly used invasive medical devices introduced into the human body, such as various catheters, tracheotomy tubes, stents, prostheses, implants and pacemakers which develop the biofilm on their surfaces due to fungi.…”

Unifying Themes in Microbial Associations with Animal and Plant Hosts Described Using the Gene Ontology

“…Adhesins have been extensively characterized for the fungus Candida albicans, a normally commensal symbiont of humans that can cause mucosal infections in healthy individuals and which may be fatal in immunocompromised individuals (165,186). Several components of the Candida cell wall, such as chitin, ␤-glucan, and lipids, may be involved in the adhesion process, although specific attachment proteins (adhesins) have been identified and have been described as being the most significant mediators in the interaction (56).…”