Abstract:IntroductionOver 5,000 cases of invasive Candida species infections occur in the United Kingdom each year, and around 40% of these cases occur in critical care units. Invasive fungal disease (IFD) in critically ill patients is associated with increased morbidity and mortality at a cost to both the individual and the National Health Service. In this paper, we report the results of a systematic review performed to identify and summarise the important risk factors derived from published multivariable analyses, ri… Show more
“…s the number of patients with profound immunosuppression (such as those with solid-organ and hematopoietic stem cell transplants) continues to rise, the morbidity and mortality burdens attributed to invasive fungal infections are increasing (1)(2)(3)(4)(5)(6). In the case of invasive fungal infections, expedient identification of the offending organism is essential for optimal patient management and the best clinical outcomes.…”
The optimal management of fungal infections is correlated with timely organism identification. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) is revolutionizing the identification of yeasts isolated from clinical specimens. We present a multicenter study assessing the performance of the Vitek MS system (bioMérieux) in identifying medically important yeasts. A collection of 852 isolates was tested, including 20 Candida species (626 isolates, including 58 C. albicans, 62 C. glabrata, and 53 C. krusei isolates), 35 Cryptococcus neoformans isolates, and 191 other clinically relevant yeast isolates; in total, 31 different species were evaluated. Isolates were directly applied to a target plate, followed by a formic acid overlay. Mass spectra were acquired using the Vitek MS system and were analyzed using the Vitek MS v2.0 database. The gold standard for identification was sequence analysis of the D2 region of the 26S rRNA gene. In total, 823 isolates (96.6%) were identified to the genus level and 819 isolates (96.1%) were identified to the species level. Twenty-four isolates (2.8%) were not identified, and five isolates (0.6%) were misidentified. Misidentified isolates included one isolate of C. albicans (n ؍ 58) identified as Candida dubliniensis, one isolate of Candida parapsilosis (n ؍ 73) identified as Candida pelliculosa, and three isolates of Geotrichum klebahnii (n ؍ 6) identified as Geotrichum candidum. The identification of clinically relevant yeasts using MS is superior to the phenotypic identification systems currently employed in clinical microbiology laboratories.
“…s the number of patients with profound immunosuppression (such as those with solid-organ and hematopoietic stem cell transplants) continues to rise, the morbidity and mortality burdens attributed to invasive fungal infections are increasing (1)(2)(3)(4)(5)(6). In the case of invasive fungal infections, expedient identification of the offending organism is essential for optimal patient management and the best clinical outcomes.…”
The optimal management of fungal infections is correlated with timely organism identification. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) is revolutionizing the identification of yeasts isolated from clinical specimens. We present a multicenter study assessing the performance of the Vitek MS system (bioMérieux) in identifying medically important yeasts. A collection of 852 isolates was tested, including 20 Candida species (626 isolates, including 58 C. albicans, 62 C. glabrata, and 53 C. krusei isolates), 35 Cryptococcus neoformans isolates, and 191 other clinically relevant yeast isolates; in total, 31 different species were evaluated. Isolates were directly applied to a target plate, followed by a formic acid overlay. Mass spectra were acquired using the Vitek MS system and were analyzed using the Vitek MS v2.0 database. The gold standard for identification was sequence analysis of the D2 region of the 26S rRNA gene. In total, 823 isolates (96.6%) were identified to the genus level and 819 isolates (96.1%) were identified to the species level. Twenty-four isolates (2.8%) were not identified, and five isolates (0.6%) were misidentified. Misidentified isolates included one isolate of C. albicans (n ؍ 58) identified as Candida dubliniensis, one isolate of Candida parapsilosis (n ؍ 73) identified as Candida pelliculosa, and three isolates of Geotrichum klebahnii (n ؍ 6) identified as Geotrichum candidum. The identification of clinically relevant yeasts using MS is superior to the phenotypic identification systems currently employed in clinical microbiology laboratories.
“…It is likely that these patients were then started on ECs, potentially enriching the EC prophylaxis group with patients with baseline toxicities and greater comorbidities. Inability to tolerate oral medications, switching to EC prophylaxis due to toxicity, and liver disease are also likely surrogate markers for severity of illness, another predictor of IFIs (9,10). The lowest rate of IFI in this study was actually seen in the fluconazole group (Fig.…”
“…According to the panel's opinion, LoS in the ICU and total days on mechanical ventilation, the presence of CVC/TPN, dialysis catheters, use of broad spectrum antibiotics, sepsis, presence of GI surgery, burn and high Acute Physiology and Chronic Health Evaluation II Score (> 16) [61] were considered as main risk factors justifying the empirical antifungal therapy against IC in febrile, non-neutropenic critically-ill patients admitted to the ICU.…”
Invasive candidiasis (IC) bears a high risk of morbidity and mortality in the intensive care units (ICU). With the current advances in critical care and the use of widespectrum antibiotics, invasive fungal infections (IFIs) and IC in particular, have turned into a growing concern in the ICU. Further to blood cultures, some auxil-
REVIEW
102November 4, 2014|Volume 3|Issue 4| WJCCM|www.wjgnet.com iary laboratory tests and biomarkers are developed to enable an earlier detection of infection, however these test are neither consistently available nor validated in our setting. On the other hand, patients' clinical status and local epidemiology data may justify the empiric antifungal approach using the proper antifungal option. The clinical approach to the management of IC in febrile, non-neutropenic critically ill patients has been defined in available international guidelines; nevertheless such recommendations need to be customized when applied to our local practice. Over the past three years, Iranian experts from intensive care and infectious diseases disciplines have tried to draw a consensus on the management of IFI with a particular focus on IC in the ICU. The established IFI-clinical forum (IFI-CF), comprising the scientific leaders in the field, has recently come up with and updated recommendation on the same (June 2014). The purpose of this review is to put together literature insights and Iranian experts' opinion at the IFI-CF, to propose an updated practical overview on recommended approaches for the management of IC in the ICU. Core tip: The present consensus statement has attempted to summarize the practical highlights regarding the management of Invasive Candidiasis (IC) in critical care setting. This easy-to-follow clinical pathway is expected to be not only of interest but also of clinical use for those who deal with the management of invasive fungal infections in hospital setting and especially the intensive care units. The focus of this paper is the concept of timely management of IC in critically ill patients.
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