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

Intensive Care Medicine - Tập 35 - Trang 206-214 - 2008
Benoît P. Guery1, Maiken C. Arendrup2, Georg Auzinger3, Élie Azoulay4, Márcio Borges Sá5, Elizabeth M. Johnson6, Eckhard Müller7, Christian Putensen8, Coleman Rotstein9, Gabriele Sganga10, Mario Venditti11, Rafael Zaragoza Crespo12, Bart Jan Kullberg13
1Infectious Diseases, SGRIVI, Hopital Huriez, CHRU Lille, Lille Cedex, France
2Unit of Mycology, Department Bacteriology, Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark
3Liver Intensive Care, Institute of Liver Studies, King’s College Hospital, London, UK
4Service de Réanimation Médicale, Hôpital Saint-Louis, Paris, France
5Sepsis Unit, Intensive Care Department, Hospital Son Llàtzer, Palma de Mallorca, Spain
6Mycology Reference Laboratory, National Collection of Pathogenic Fungi, The HPA Centre for Infections, HPA South West Laboratory, Bristol, UK
7Universitätsklinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Knappschaftskrankenhaus Bochum, Langendreer, Klinikum der Ruhr-Universität, Bochum, Germany
8Operative Intensivmedizin, Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Rheinische-Friedrich-Wilhelms Universität Bonn, Bonn, Germany
9Division of Infectious Diseases, University Health Network, Toronto General Hospital, Toronto, Canada
10Department of Surgery, Division of General Surgery and Organ Transplantation, Policlinico ‘A Gemelli’, Catholic University, Rome, Italy
11Internal Medicine, Clinical Medicine Department, “La Sapienza” University, Rome, Rome, Italy
12Secretario GTEI-SEMICYUC, Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, Spain
13Department of Medicine (463), Nijmegen Institute for Infection, Inflammation, and Immunity (N4i), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

Tóm tắt

Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting particularly in the intensive care unit (ICU). 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. 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 with fluconazole resistant strains or there has been recent past exposure to an azole (<30 days). In contrast, pre-emptive therapy is based on the presence of surrogate markers.

Tài liệu tham khảo

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