Timely selection of adequate antifungal therapy for candidemia in the critically ill: Donʼt let the yeast rise!*

Abstract

enth of the Barnes-Jewish cases of candidemia and the highest proportion that were inadequately treated (37.1%). As fluconazole is a relatively nontoxic agent, arguably all patients should commence on 12 mg/kg fluconazole (adjusted if renal failure is present) and the dosage reduced, if appropriate, once the species is identified.

Candida bloodstream infections: comparison of species distribution and resistance to echinocandin and azole antifungal agents in Intensive Care Unit (ICU) and non-ICU settings in the SENTRY Antimicrobial Surveillance Program (2008–2009)

“…Concurrent with increasing numbers of invasive candidal infections, surveillance programmes have become important in defining the species distribution and antifungal resistance patterns of the responsible pathogens, and thus are providing the information necessary for appropriate empirical antifungal therapy [1][2][3][4][5][6]. Data from several sources show that mortality rates and resource utilisation increase significantly when empirical therapy is delayed or inadequate (wrong dose, resistant isolate), further underscoring the importance of detailed epidemiological data [1,4,[7][8][9][10][11][12][13].…”

Wild-Type MIC Distributions and Epidemiological Cutoff Values for Posaconazole and Voriconazole and Candida spp. as Determined by 24-Hour CLSI Broth Microdilution

“…achieve suitable growth for MIC testing by 24 h of incubation (14)(15)(16)36). Given the facts that a shorter incubation period is more efficient and practical for use in the clinical laboratory (16,36) and that research has shown that early/ correct antifungal treatment has a positive effect on outcomes for patients with candidemia (5,6,12,19,20,23,27,29,33,53), the CLSI has determined that fluconazole MICs may be used after a 24-h incubation, providing earlier clinically useful information to clinicians caring for patients with invasive candidiasis (IC) (31,36). Currently, the CLSI recommends that MICs for the newer triazoles, posaconazole and voriconazole, be read after 48 h of incubation for testing of Candida spp.…”

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

“…The clinical outcome in patients with invasive candidiasis largely depends on the timeliness in antifungal therapy (Hope et al, 2012;Ullmann et al, 2012). Many clinical investigations have clearly shown that delayed approach in antifungal therapy has a negative impact on survival Ahmed et al, 2014;Blot, Vandewoude, Hoste, & Colardyn, 2002;Corona, Cislaghi, & Singer, 2008;Elhoufi et al, 2014;Garey et al, 2006;Mardani et al, 2011;Morrell, Fraser, & Kollef, 2005;Skrobik & Laverdiere, 2013;Viaggi, Tascini, & Menichetti, 2014;Yildirmak, Gedik, Simsek, Iris, & Gucuyener, 2013). Based upon the diagnostic possibility of IFIs, various strategies including prophylaxis, empirical, preemptive, or targeted therapy may be pursued.…”