Prophylaxis of Candida infections in adult trauma and surgical intensive care patients: a systematic review and meta-analysis

Cruciani, Mario; Lalla, Fausto de; Mengoli, Carlo

doi:10.1007/s00134-005-2794-y

Cited by 109 publications

(68 citation statements)

References 59 publications

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“…These observations are particularly important when considering the changing epidemiology of bloodstream infections for both community-acquired and hospital-acquired BSI and recent changes in the approach to treatment and prophylaxis. Improvements in diagnostic methods and implementation of prophylactic treatment of high-risk patients have been shown to reduce invasive candidiasis by as much as 50% and significantly improve clinical outcomes (6,24,32). In two recently published studies delay in treatment of candidemia was associated with increased mortality during hospitalization (12,21).…”

Section: Discussionmentioning

confidence: 99%

Comparison of BD Bactec Plus Aerobic/F Medium to VersaTREK Redox 1 Blood Culture Medium for Detection of Candida spp. in Seeded Blood Culture Specimens Containing Therapeutic Levels of Antifungal Agents

et al. 2011

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Recovery of Candida spp. using the BD Bactec FX blood culture (BC) system (Bactec Plus Aerobic/F medium) and the VersaTREK system (aerobic Redox medium) was evaluated using seeded BC bottles with and without the addition of commonly used antifungal agents. BC bottles (n ‫؍‬ 1,442) were each inoculated with 10 ml human whole blood and 0.1 ml of suspensions of Candida spp., with or without antifungal agents. BC bottles were incubated in the corresponding system for a maximum of 5 days. In the absence of antifungal agents, Bactec FX recovered 97.4% of Candida spp., and VersaTREK recovered 99.1% (P ‫؍‬ 0.154). With regard to length of time to detection (LTD) and overall recovery, both systems had various levels of effectiveness in recovering C. glabrata. In bottles containing antifungal agents, Bactec FX recovered 83.1% of isolates, whereas VersaTREK recovered 50.7% of Candida spp. (P < 0.001). For BC bottles without the addition of antifungal agents, the median LTD for VersaTREK was 2.2 h faster than that of Bactec FX (P < 0.001). In the presence of antifungal agents, the Bactec FX recovery time was significantly faster than that of VersaTREK (median difference of 10.8 h, P < 0.001). We conclude that both systems have comparable abilities to recover Candida spp. from seeded blood cultures in the absence of antifungal agents. In the presence of therapeutic levels of commonly used antifungal agents, the Bactec FX system demonstrated a significantly greater recovery of various Candida spp., as well as a shorter LTD.

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Section: Discussionmentioning

confidence: 99%

Comparison of BD Bactec Plus Aerobic/F Medium to VersaTREK Redox 1 Blood Culture Medium for Detection of Candida spp. in Seeded Blood Culture Specimens Containing Therapeutic Levels of Antifungal Agents

et al. 2011

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“…In an effort to provide a systematic synthesis of the benefits and harms of antifungal prophylaxis in the nonneutropenic ICU patient, several groups have conducted metaanalyses of the randomized trials in this area (Table 24) (45,103,233,270,295). The number of studies included in each analysis varied based on inclusion of trials with agents other than fluconazole, medical versus surgical ICU, or organ transplant; however, all shared a common core of at least four studies and, in the final analysis, the conclusions regarding prophylaxis were quite similar (Table 24).…”

Section: Prevention and Prophylaxismentioning

confidence: 99%

Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem

2007

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SUMMARY Invasive candidiasis (IC) is a leading cause of mycosis-associated mortality in the United States. We examined data from the National Center for Health Statistics and reviewed recent literature in order to update the epidemiology of IC. IC-associated mortality has remained stable, at approximately 0.4 deaths per 100,000 population, since 1997, while mortality associated with invasive aspergillosis has continued to decline. Candida albicans remains the predominant cause of IC, accounting for over half of all cases, but Candida glabrata has emerged as the second most common cause of IC in the United States, and several less common Candida species may be emerging, some of which can exhibit resistance to triazoles and/or amphotericin B. Crude and attributable rates of mortality due to IC remain unacceptably high and unchanged for the past 2 decades. Nonpharmacologic preventive strategies should be emphasized, including hand hygiene; appropriate use, placement, and care of central venous catheters; and prudent use of antimicrobial therapy. Given that delays in appropriate antifungal therapy are associated with increased mortality, improved use of early empirical, preemptive, and prophylactic therapies should also help reduce IC-associated mortality. Several studies have now identified important variables that can be used to predict risk of IC and to help guide preventive strategies such as antifungal prophylaxis and early empirical therapy. However, improved non-culture-based diagnostics are needed to expand the potential for preemptive (or early directed) therapy. Further research to improve diagnostic, preventive, and therapeutic strategies is necessary to reduce the considerable morbidity and mortality associated with IC.

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“…A systematic review of published antifungal prophylaxis studies carried out in the ICU setting evaluated whether systematic antifungal therapy could decrease morbidity and mortality [12]. Prophylaxis with an azole was associated with a reduced rate of candidemia, as well as a decrease of Candida-attributable mortality and overall mortality rates.…”

Section: Prophylactic Antifungal Treatment In the Icumentioning

confidence: 99%

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

et al. 2008

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Background: Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting particularly in the intensive care unit (ICU). Objective and methods: 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. Results and conclusions: 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 Intensive Care Med

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Prophylaxis of Candida infections in adult trauma and surgical intensive care patients: a systematic review and meta-analysis

Cited by 109 publications

References 59 publications

Comparison of BD Bactec Plus Aerobic/F Medium to VersaTREK Redox 1 Blood Culture Medium for Detection of Candida spp. in Seeded Blood Culture Specimens Containing Therapeutic Levels of Antifungal Agents

Comparison of BD Bactec Plus Aerobic/F Medium to VersaTREK Redox 1 Blood Culture Medium for Detection of Candida spp. in Seeded Blood Culture Specimens Containing Therapeutic Levels of Antifungal Agents

Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem

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

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