CandidaProphylaxis and Therapy in the ICU

Abstract

The incidence of invasive candidiasis in critically ill patients has increased over the past decade and is associated with considerable morbidity and mortality. CANDIDA is identified in up to 17% of ICU patients, with candidemia occurring in ∼1%. CANDIDA ALBICANS continues to account for approximately half of the invasive candidiasis cases, with non- ALBICANS CANDIDA species, such CANDIDA GLABRATA, increasing in frequency. Diagnosis of invasive candidiasis is commonly based on blood culture results; however, the sensitivity of blood culture to identify CANDIDA is low. Because early, appropriate therapy has been associated with improved outcomes, antifungal therapy is being implemented in critically ill patients with risk factors for candidemia (prophylaxis). Systemic antifungal therapy is also being utilized in patients at increased risk for invasive candidiasis based on surrogate markers of infection such as colonization (preemptive therapy), or in patients with unresolving sepsis despite appropriate management (empirical therapy). Recent guidelines on the use of antifungal therapy have better identified patients who can be treated with azole derivatives and those who may benefit from echinocandins or polyenes. However, prospective trials are still needed to better identify appropriate therapy for patients at risk for, or with, confirmed invasive CANDIDA infections.

Comparison of the Bactec Fx Plus, Mycosis IC/F, Mycosis/F Lytic Blood Culture Media and the BacT/Alert 3D FA Media for Detection of Candida species in Seeded Blood Culture Specimens Containing Therapeutic Peak Levels of Fluconazole

“…This incidence is slightly higher than that of other reports (6,7). The main pathogens of candidemia are Candida albicans, C. parapsilosis, C. tropicalis, and C. glabrata (8). Candida albicans is known to be the most common pathogen of blood stream infections among the Candida species (9) but non-albicans Candida species have been increasing in frequency (3,8).…”

“…The main pathogens of candidemia are Candida albicans , C. parapsilosis , C. tropicalis , and C. glabrata . Candida albicans is known to be the most common pathogen of blood stream infections among the Candida species but non‐ albicans Candida species have been increasing in frequency . Candidemia is associated with ICU and hospital stays and has variable mortality from 5% to 71% .…”

“…Candidemia is associated with ICU and hospital stays and has variable mortality from 5% to 71% . Therefore, it is important to identify and treat Candida species as early as possible to reduce mortality . Prophylactic or empirical treatment is also suggested in patients at high risk for candidemia , and so antifungal treatment is often administered before the collection of blood cultures.…”

“…Therefore, it is important to identify and treat Candida species as early as possible to reduce mortality . Prophylactic or empirical treatment is also suggested in patients at high risk for candidemia , and so antifungal treatment is often administered before the collection of blood cultures. However, according to Riedel et al, this may have an impact on microbiological recovery of yeast from patients’ blood culture .…”

Multicenter Study Evaluating the Vitek MS System for Identification of Medically Important Yeasts

“…As the antifungal susceptibility profiles for many fungi (both yeasts and molds) are predictable, organism identification frequently is sufficient to expedite appropriate empirical antifungal therapy. This has been demonstrated both to reduce the overall length of hospitalization and to maximize favorable clinical outcomes (7)(8)(9)(10). Conversely, the rapid exclusion of overt pathogenic or intrinsically resistant species can be used to narrow therapy and/or to prevent treatment with potentially toxic antifungal agents, thereby reducing negative clinical outcomes and costs.…”