Invasive fungal infections in critically-ill patients: A literature review and position statement from the IFI-clinical forum, Shiraz, Iran

Abstract

Invasive fungal infections (IFIs) have increasingly been recognized as a serious clinical concern in critically-ill patients admitted to the intensive care units (ICUs). The most abundant pathogens in this population are Candida species. As such, a clear understanding on the epidemiology of this infection seems to be a key step in providing appropriate treatment. Expert input forums are among the practical approaches to defi ne locally-adapted clinicalpathways with regard to debated medical perspectives. To agree upon a shared approach towards IFI management in ICU, an interdisciplinary panel of experts from infectious diseases and intensive care fi elds met up in Shiraz on 28 November 2015 within the IFI-Clinical Forum (IFI-CF).This clinical forum aimed to view the available evidence, taking into consideration the recent practice guidelines on IFIs management in the ICU to arrive at an agreed position in current clinical practice. The aim of this summary is to discuss IFIs in ICU from epidemiology, the range of pathophysiology from colonization to the invasive infections, risk prediction, diagnosis and treatment perspectives.

Complicated bilateral fungal emphysematous pyelonephritis in a 55-year-old diabetic female: A case report and review of literature

“…According to different reports, fever and candiduria are the most predominant primary symptoms pertaining to Candida pyelonephritis [ 7 ]. The mortality of invasive candidiasis may be 40-60% [ 10 ].…”

Impact of antifungal stewardship interventions on the susceptibility of Candida species in pediatric patients with malignancy

“…The prevalence of Candida infections is on the rise as a result of excessive usage of broad-spectrum antibiotics, HIV infection, malignancies, transplants, invasive procedures, and prolonged hospitalization [1][2][3]. More than 17 different species of Candida are recognized that can infect humans, and amongst them, 90% of all invasive infections are related to C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei [4,5].…”

Direct Detection of Candida albicans with a Membrane Based Electrochemical Impedance Spectroscopy Sensor

“…Candidiasis is mainly an endogenous infection produced by the overgrowth of fungi due to physiological changes in the body, e.g., the imbalances in the gut microbiota [ 3 , 6 , 7 ]. However, it can also be acquired from sources like catheters or prosthetic devices, by person-to-person or vertical transmission [ 1 , 3 , 6 , 8 , 9 ]. When the infection spreads to the bloodstream it is referred to as invasive candidiasis and can spread to other body organs [ 2 ].…”

“…The weakness of this method is primarily the time-to-answer, which takes at least 2 days but also its low sensitivity as various factors affect the growth of C. albicans in a laboratory setting [ 1 ]. Other diagnostic tests based on detection of C. albicans cell wall components, mainly polysaccharides, such as mannan and -D-glucan are considered beneficial [ 4 , 5 , 8 , 9 ]. However, their diagnostic value is undermined by many described cases of false positive results, as their concentration in blood is not specific and can be affected by dietary requirements or former administration of drugs [ 5 , 8 ].…”

“…Although fast and species specific, this method amplifies also DNA from non-viable C. albicans cells, leading to false positives [ 5 , 11 ]. Other diagnostic methods involving detection of host anti- Candida specific antibodies are a valid choice but their use in immunodeficient patients is limited [ 8 , 9 ]. Another measurable indication of a fungal infection is the ratio of D-/L-arabitol in urine, which has a strong diagnostic value among neonatal patients [ 12 ].…”