Septic Shock Attributed to Candida Infection: Importance of Empiric Therapy and Source Control

Kollef, Marin H.; Micek, Scott T.; Hampton, Nicholas; Doherty, Joshua A.; Kumar, Anand

doi:10.1093/cid/cis305

Cited by 390 publications

(317 citation statements)

References 36 publications

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“…The advantage of echinocandin therapy over azoles was demonstrated in patients with low and moderately high APACHE II scores, suggesting that the survival benefit from echinocandin treatment is not limited to severely ill patients [55]. Multiple cohort studies have identified treatment with an echinocandin to be independently associated with better survival in multivariate analyses, e.g., in severely ill patients with candidemia and septic shock [82], and in patients infected by C. glabrata [83].…”

Section: What Are Remaining Areas Of Uncertainty? Invasive Candidiasismentioning

confidence: 99%

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

et al. 2017

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Purpose:To describe concisely the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to Candida and Aspergillus infections in non-neutropenic patients in the ICU setting. Methods:A systematic review of the medical literature taking account of national and international guidelines and expert opinion. Results:Severe invasive fungal infections (IFIs) are becoming increasingly frequent in critically ill patients. Approximately 80% of IFIs are due to Candida spp. and 0.3-19% to Aspergillus spp. Recent observations emphasize the necessity of building a worldwide sentinel network to monitor the emergence of new fungal species and changes in susceptibility. Robust data on the attributable mortality are essential for the design of clinical studies with mortality endpoints. Although early antifungal therapy for Candida has been recommended in patients with risk factors, sepsis of unknown cause, and positive Candida serum biomarkers [β-1 → 3-d-glucan (BDG) and Candida albicans germ tube antibody (CAGTA)], its usefulness and influence on outcome need to be confirmed. Future studies may specifically address the optimal diagnostic and therapeutic strategies for patients with abdominal candidiasis. Better knowledge of the pharmacokinetics of antifungal molecules and tissue penetration is a key issue for intensivists. Regarding invasive aspergillosis, further investigation is needed to determine its incidence in the ICU, its relationship with influenza outbreaks, the clinical impact of rapid diagnosis, and the significance of combination treatment. Conclusions:Fundamental questions regarding IFI have to be addressed over the next decade. The clinical studies described in this research agenda should provide a template and set priorities for the clinical investigations that need to be performed.

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Section: What Are Remaining Areas Of Uncertainty? Invasive Candidiasismentioning

confidence: 99%

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

et al. 2017

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“…Studies have shown that outcome of Candida sepsis is closely related to both factors (Garey et al 2006; Kumar et al 2006; Kollef et al 2012). Although several studies in our data set did comment on the frequency of catheter removal, outcomes were not stratified by this variable (Phillips et al 1997; Rex et al 2003; Kullberg et al 2005).…”

Section: Discussionmentioning

confidence: 99%

Fungicidal versus fungistatic therapy of invasive Candida infection in non-neutropenic adults: a meta-analysis

et al. 2018

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The purpose of this study was to determine whether fungicidal versus fungistatic pharmacotherapy of invasive candidiasis/candidemia yields superior outcomes.Data sources included MEDLINE (1966–June 2017), EMBASE (1980–June 2017), PubMed (1966–June 2017), Global Health-Ovid (inception to June 2017), LILACS Virtual Health Library (inception to June 2017) and the Cochrane Central Register of Controlled Trials (to 2nd quarter 2017). The ClinicalTrial.gov database, the SCOPUS database, SIGLE (System for Information on Grey Literature) and Google Scholar were also utilised to search for relevant studies.Randomised studies of any pharmacotherapy of invasive candidiasis including candidemia using a fungicidal (amphotericin B or echinocandin compound) versus a fungistatic (triazole) compound in adolescent or adult non-neutropenic patients. Eight studies met the inclusion criteria.Pooled odds ratios demonstrated an advantage of fungicidal therapy with respect to early therapeutic success (OR 1.61, 95% CI 1.27–2.03, p < 0.0001, I2 = 0%) and persistence or recurrence of infection (OR 0.51, 95% CI 0.35–0.74, p = 0.0005, I2 = 0%) but no advantage for late survival (OR 0.97, 95% CI 0.77–1.21, p = 0.77, I2 = 0%).Fungicidal therapy of invasive candidiasis and candidemia is associated with a higher probability of early therapeutic success and decreased probability of persistent or recurrent infection. However, there is no improvement in survival.

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“…Eine solche zielgerichtete Therapie soll bis 14 Tage nach der ersten negativen Blutkultur fortgeführt werden. Dieses Vorgehen beinhaltet jedoch ein zeitliches Problem, da der Kulturnachweis von Candida-Spezies mehrere Tage in Anspruch nehmen kann und das Sterberisiko für den Patienten mit einer unbehandelten invasiven Candida-Infektion täglich steigt [5]. Aus diesem Grund nennt die Leitlinie noch andere Therapiestrategien, die das Zeitproblem umgehen sollen [3].…”

Section: Dilemma In Der Behandlung Der Invasiven Candida-mykoseunclassified

Behandlung invasiver Mykosen

Bloos

2015

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Septic Shock Attributed to Candida Infection: Importance of Empiric Therapy and Source Control

Abstract: The risk of death is exceptionally high among patients with septic shock attributed to Candida infection. Efforts aimed at timely source control and antifungal treatment are likely to be associated with improved clinical outcomes.

Cited by 390 publications

References 36 publications

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

Fungicidal versus fungistatic therapy of invasive Candida infection in non-neutropenic adults: a meta-analysis

Behandlung invasiver Mykosen

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