Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part II. Treatment

Abstract

Background: Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting particularly in the intensive care unit (ICU). Objective and methods: To review the current management of invasive candidiasis and candidemia in non-neutropenic adult ICU patients based on a review of the literature and an European expert panel discussion. Results and conclusions: Empiric and directed treatment for invasive candidiasis are predicated on the hemodynamic status of the patient. Unstable patients may benefit from broad-spectrum antifungal agents, which can be narrowed once the patient has stabilized and the identity of the infecting species is established. In stable patients, a more classical approach using fluconazole may be satisfactory provided that the patient is not colonized Intensive Care Med

Evaluation of Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry for Identification of Clinically Important Yeast Species

“…Invasive fungal infections due to opportunistic pathogens are a significant cause of morbidity and mortality (2,5,8). The current rise in fungal infections correlates with the widespread use of broad-spectrum antibacterial agents, prolonged hospitalization of critically ill patients, and the increased number of immunocompromised patients.…”

“…has occurred (2,29). Treatment with amphotericin B may be useful for these organisms and inefficient for those belonging to other genera (5,8). While many Candida species remain susceptible to fluconazole, it is important to differentiate the more resistant organisms, namely, Candida glabrata, Candida krusei, Rhodotorula spp., and some members of the genus Trichosporon.…”

Accurate and Rapid Identification of Candida spp. Frequently Associated with Fungemia by Using PCR and the Microarray-Based Prove-it Sepsis Assay

“…are the 4th most common causative agents of nosocomial bloodstream infections (BSIs) in the United States and the 5th to 10th most common cause in Europe and Australia (6,8,36). Candida albicans remains the predominant species in these infections, although recent data suggest an increase in the proportion of Candida species other than C. albicans, such as C. tropicalis, C. parapsilosis, C. glabrata, and C. krusei (3, 4, 8, 16, 17, 34).Candidemia is associated with a high mortality rate, a prolonged length of hospital stay, and high hospital costs (13,15,17,26,29,35). Appropriate antifungal therapy administered in a timely fashion impacts morbidity and mortality and costs of treatment (14,15,20,25).…”

“…Appropriate antifungal therapy administered in a timely fashion impacts morbidity and mortality and costs of treatment (14,15,20,25). Currently, suspected candidemia is diagnosed by blood culture, subsequent Gram staining, and various diagnostic practices, including a germ tube assay and various morphological and biochemical identification methods.…”

“…Candidemia is associated with a high mortality rate, a prolonged length of hospital stay, and high hospital costs (13,15,17,26,29,35). Appropriate antifungal therapy administered in a timely fashion impacts morbidity and mortality and costs of treatment (14,15,20,25).…”