Invasive Candida infections in the ICU

Abstract

Summary Invasive candidiasis, including candidemia and deep‐seated Candida infections, is a severe opportunistic infection with an overall mortality in ICU patients comparable to that of severe sepsis/septic shock. With an incidence ranging from 5 to 10 cases per 1000 ICU admissions, invasive candidiasis represents 5–10% of all ICU‐acquired infections. Although a high proportion of critically ill patients is colonised with Candida spp., only 5–40% develop an invasive infection. The occurrence of this complication is difficult to predict and an 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 non‐culture based laboratory techniques may contribute to early diagnosis and management of invasive candidiasis. Recent data suggest that prediction rules based on risk factors, clinical and microbiological parameters or monitoring of Candida colonisation may efficiently identify critically ill patients at high risk of invasive candidiasis who may benefit of preventive or pre‐emptive antifungal therapy. In many cancer centres, exposure to azoles antifungals has been associated with an epidemiological shift from Candida albicans to non‐albicans Candida species with reduced antifungal susceptibility or intrinsic resistance. This trend has not been observed in recent surveys on candidemia in non‐immunocompromised ICU patients. Prophylaxis, pre‐emptive or empirical antifungal treatment are possible approaches for prevention or early management of invasive candidiasis. However, the selection of high‐risk patients remains critical for an efficient management aimed at reducing the number needed to treat and thus avoiding unnecessary treatments associated with the emergence of resistance, drug toxicity and costs.

Candida spp. co-infection in COVID-19 patients with severe pneumonia: Prevalence study and associated risk factors

“…Although it is described high critically ill patients colonized with Candida spp., only 5-40% develop an invasive infection [17]. In the last decades, many risk factors associated with IC development have been identified (diabetes mellitus, renal failure, urinary or vascular catheters, neutropenia, immunosuppression, major surgery, neutropenia, burns, among others) [18]. IFI, especially IA, are well-known complications of influenza [19].…”

COVID-19 Is an Independent Risk Factor for Detrimental Invasive Fungal Disease in Patients on Veno-Venous Extracorporeal Membrane Oxygenation: A Retrospective Study

“…On the other hand, the COVID-19 patients were in a less critical condition, while severity of illness was a risk factor for candidemia in earlier studies [53]. In addition, less COVID-19 patients had CKRT, and renal failure has been identified as another risk factor for candidemia [1,8,9,[54][55][56][57][58]. Other supportive treatments, such as parenteral nutrition and broad-spectrum antibiotic therapy, were highly standardized in our institution, as outlined before [2].…”

Epidemiological analysis of systemic mycoses in COVID-19

“…Диагноз мукоромикоза ставится прямой микоскопией или в сочетании с флюоресцентной микроскопией таких клинических образцов, как мокрота, жидкость брохоальвеолярного лаважа, где выявляются септированные или частично септированные гифы размером 6-16 мкм. Достаточно перспективным является идентификация ДНК в сыворотке, в некоторых клинических ситуациях ПЦР [16,17].…”

“…При этом большинство клиницистов сходятся во мнении, что системные микозы у пациентов с COVID-19 не являются сравнительно новой ситуацией: грибково-бакте ри альные или вирусно-грибковые коинфекции были описаны еще во время вспышек гриппа H1N1 или H7N9 [13,16,17]. Вместе с тем состав вирусной составляющей был представлен не только ведущими возбудителями − вирусами гриппа H1N1 или H7N9, но и другими вирусами респираторного тракта, среди которых риносинцитиальный вирус, аденовирусы и мн.…”