On track to limit antifungal overuse!

Eggimann, Philippe; Lamoth, Frédéric; Marchetti, Oscar

doi:10.1007/s00134-009-1432-5

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…However, critically ill patients are being colonized progressively during their ICU stay. The accuracy of a single-point assessment is low and such rule may be responsible for overuse of antifungals [56]. As initially proposed by Pittet et al and confirmed by other investigators, a periodic evaluation of the dynamics of colonization in surgical patients at risk may predict more accurately the development of an invasive candidiasis [21,57-60].…”

Section: Epidemiology Of Invasive Candidiasismentioning

confidence: 99%

Diagnosis of invasive candidiasis in the ICU

Eggimann

Billé

Marchetti

2011

Ann. Intensive Care

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117

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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.

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Section: Epidemiology Of Invasive Candidiasismentioning

confidence: 99%

Diagnosis of invasive candidiasis in the ICU

Eggimann

Billé

Marchetti

2011

Ann. Intensive Care

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117

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“…Antifungal prophylaxis should be considered for burn patients with those susceptive factors, and the course of empirical antifungals is advised for 1 to 2 weeks 46 . It has been indicated that fungal resistance is emerging during the past decade, especially in Candida species 8,47 . Once the results of sensitivities are available, effective antifungal agents should be systemically or topically administered as soon as possible.…”

Section: Discussionmentioning

confidence: 99%

“…Still, some troubles exist in the clinical management of fungal infection in burn patients. First, antifungal prophylaxis in burn patients remains controversial as it may lead to resistances and increased costs 8 . Besides, the diagnostic methods of fungal infection vary between studies.…”

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confidence: 99%

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Fungal Infection in Burn Patents

Lineaweaver

Breland

2021

Ann Plast Surg

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Objectives The aims of this study were to review recent fungal infection case reports published, evaluate the treatment regimens and clinical outcomes, and provide recommendations for future management. Methods A review of case reports published over the last decade was conducted. PubMed was searched to collect the relevant citations using a combination of the key words (“burn,” “burned,” “burns,” “fungal,” “fungi,” and “fungus”) in title or abstract. Case series, reviews, guidelines, and experimental and non-English studies were excluded. Statistical analyses were performed using Microsoft Excel 2019. Results A total of 36 case reports encompassing a total of 44 burn patients with fungal infection were included in the final analysis. Ablative surgeries, including surgical excision, debridement, skin graft, vitrectomy, teeth extraction, valve replacement, or amputation, were performed in 38 cases after the suspicion or identification of fungal infection. Twenty-nine of them were eventually discharged, yielding a survival rate of 76.3%. In the remaining 6 cases, ablative surgery was not mentioned and 3 of them eventually died, yielding a survival rate of 50%. The total mortality was 27.27%. Among the 12 death cases, 1 was infected with Candida albicans, 1 with non-albicans Candida, 2 with Aspergillus spp, 2 with Fusarium spp, 4 with Zygomycetes, and 2 with other fungal species. Conclusions The overall mortality of fungal wound infection is still high in burn patients around the world, especially those infected with non-Candida species. Early diagnosis of fungal infection, early initiation of appropriate antifungal therapy, and effective surgical intervention are key measures to improve the treatment effect and reduce the mortality of fungal infection in burn patients.

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“…catheter tip in the absence of candidaemia remains uncertain. 66 Choice of media and species identification Standard bacteriological vs special fungal agar media. Selective fungal media are preferred in order to allow detection of fungi in polymicrobial specimens.…”

Section: Culturementioning

confidence: 99%

ECIL-3 classical diagnostic procedures for the diagnosis of invasive fungal diseases in patients with leukaemia

Arendrup

Billé²,

Dannaoui

et al. 2012

Bone Marrow Transplant

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Invasive fungal diseases (IFDs) continue to cause considerable morbidity and mortality in patients with haematological malignancy. Diagnosis of IFD is difficult, with the sensitivity of the gold standard tests (culture and histopathology) often reported to be low, which may at least in part be due to sub-optimal sampling or subsequent handling in the routine microbiological laboratory. Therefore, a working group of the European Conference in Infections in Leukaemia was convened in 2009 with the task of reviewing the classical diagnostic procedures and providing recommendations for their optimal use. The recommendations were presented and approved at the ECIL-3 conference in September 2009. Although new serological and molecular tests are examined in separate papers, this review focuses on sample types, microscopy and culture procedures, antifungal susceptibility testing and imaging. The performance and limitations of these procedures are discussed and recommendations are provided on when and how to use them and how to interpret the results.

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On track to limit antifungal overuse!

Cited by 7 publications

References 17 publications

Diagnosis of invasive candidiasis in the ICU

Diagnosis of invasive candidiasis in the ICU

Fungal Infection in Burn Patents

ECIL-3 classical diagnostic procedures for the diagnosis of invasive fungal diseases in patients with leukaemia

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