Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care

Abstract

The incidence of systemic Candida infections in patients requiring intensive care has increased substantially in recent years as a result of a combination of factors. More patients with severe underlying disease or immunosuppression from anti-neoplastic or anti-rejection chemotherapy and at risk from fungal infection are now admitted to the ICU. Improvements in supportive medical and surgical care have led to many patients who would previously have died as a result of trauma or disease surviving to receive intensive care. Moreover, some therapeutic interventions used in the ICU, most notably broad-spectrum antibiotics and intravascular catheters, are also associated with increased risks of candidiasis. Systemic Candida infections are associated with a high morbidity and mortality, but remain difficult to diagnose and ICU staff need to be acutely aware of this often insidious pathogen. A number of studies have identified risk factors for systemic Candida infection which may be used to identify those at highest risk. Such patients may be potential candidates for early, presumptive therapy. Here we review the epidemiology, pathogenesis, morbidity and mortality of systemic Candida infections in the ICU setting, and examine predisposing risk factors. Antifungal treatment, including the use of amphotericin B, flucytosine and fluconazole, and the roles of early presumptive therapy and prophylaxis, is also reviewed.

Combined detection of mannanaemia and anti-mannan antibodies as a strategy for the diagnosis of systemic infection caused by pathogenic Candida species

“…In the 1980s, Candida species were reported to be the seventh most common nosocomial pathogens hospitalwide, ranking fourth in intensive care units (ICUs) where they accounted for c. 10% of all bloodstream infections [5][6][7]. This general incidence has continued in the past decade in the USA [8], as well as in Europe [9][10][11][12]. Despite the high morbidity and mortality associated with candidosis, no decrease in the incidence of this infection has yet been achieved.…”

Aetiology and antifungal susceptibility of yeast bloodstream infections in a Hungarian university hospital between 1996 and 2000

“…Despite the fact that blood cultures remain the basic tool for the diagnosis of fungaemia, this method may fail to detect as many as 50% of disseminated candidosis cases. The concomitant colonisation of mucosal surfaces by the same Candida species may be the only laboratory sign of a systemic fungal infection in immunocompromised patients [6][7][8].…”

The persistence of multifocal colonisation by a single ABC genotype of Candida albicans may predict the transition from commensalism to infection

“…The intensity of Candida colonisation in critically ill patients may predict subsequent infections with identical strains (Pittet et al 1994, Vincent et al 1998. Recently, Leon et al (2006) developed a scoring system named the "Candida score" and proved that patients with Candida multifocal colonisation had higher overall mortality rates compared to those patients with unifocal colonisation by this yeast.…”