How to Treat Fungal Infections in ICU Patients

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2015 May 2

PMID 25930035

Citations 16

Authors

Dimitrios K Matthaiou

Theodora Christodoulopoulou

George Dimopoulos

Affiliations

Soon will be listed here.

Abstract

Fungal infections represent a major burden in the critical care setting with increasing morbidity and mortality. Candidiasis is the leading cause of such infections, with C. albicans being the most common causative agent, followed by Aspergillosis and Mucormycosis. The diagnosis of such infections is cumbersome requiring increased clinical vigilance and extensive laboratory testing, including radiology, cultures, biopsies and other indirect methods. However, it is not uncommon for definitive evidence to be unavailable. Risk and host factors indicating the probability of infections may greatly help in the diagnostic approach. Timely and adequate intervention is important for their successful treatment. The available therapeutic armamentarium, although not very extensive, is effective with low resistance rates for the newer antifungal agents. However, timely and prudent use is necessary to maximize favorable outcomes.

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References

De Pauw B, Walsh T, Donnelly J, Stevens D, Edwards J, Calandra T . Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group.... Clin Infect Dis. 2008; 46(12):1813-21. PMC: 2671227. DOI: 10.1086/588660. View

Baddley J, Stephens J, Ji X, Gao X, Schlamm H, Tarallo M . Aspergillosis in Intensive Care Unit (ICU) patients: epidemiology and economic outcomes. BMC Infect Dis. 2013; 13:29. PMC: 3562254. DOI: 10.1186/1471-2334-13-29. View

Hizel K, Kokturk N, Kalkanci A, Ozturk C, Kustimur S, Tufan M . Polymerase chain reaction in the diagnosis of invasive aspergillosis. Mycoses. 2004; 47(7):338-42. DOI: 10.1111/j.1439-0507.2004.00944.x. View

Hajjeh R, Sofair A, Harrison L, Lyon G, Arthington-Skaggs B, Mirza S . Incidence of bloodstream infections due to Candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program. J Clin Microbiol. 2004; 42(4):1519-27. PMC: 387610. DOI: 10.1128/JCM.42.4.1519-1527.2004. View

Cordonnier C, Pautas C, Maury S, Vekhoff A, Farhat H, Suarez F . Empirical versus preemptive antifungal therapy for high-risk, febrile, neutropenic patients: a randomized, controlled trial. Clin Infect Dis. 2009; 48(8):1042-51. DOI: 10.1086/597395. View

Cornely O, Bassetti M, Calandra T, Garbino J, Kullberg B, Lortholary O . ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect. 2012; 18 Suppl 7:19-37. DOI: 10.1111/1469-0691.12039. View

Walsh T, Anaissie E, Denning D, Herbrecht R, Kontoyiannis D, Marr K . Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008; 46(3):327-60. DOI: 10.1086/525258. View

Lortholary O, Gangneux J, Sitbon K, Lebeau B, de Monbrison F, Le Strat Y . Epidemiological trends in invasive aspergillosis in France: the SAIF network (2005-2007). Clin Microbiol Infect. 2011; 17(12):1882-9. DOI: 10.1111/j.1469-0691.2011.03548.x. View

Panackal A, Parisini E, Proschan M . Salvage combination antifungal therapy for acute invasive aspergillosis may improve outcomes: a systematic review and meta-analysis. Int J Infect Dis. 2014; 28:80-94. PMC: 4237720. DOI: 10.1016/j.ijid.2014.07.007. View

10.

Leon C, Ruiz-Santana S, Saavedra P, Galvan B, Blanco A, Castro C . Usefulness of the "Candida score" for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study. Crit Care Med. 2009; 37(5):1624-33. DOI: 10.1097/CCM.0b013e31819daa14. View

11.

Perfect J, Cox G, Lee J, Kauffman C, de Repentigny L, Chapman S . The impact of culture isolation of Aspergillus species: a hospital-based survey of aspergillosis. Clin Infect Dis. 2001; 33(11):1824-33. DOI: 10.1086/323900. View

12.

Ostrosky-Zeichner L, Shoham S, Vazquez J, Reboli A, Betts R, Barron M . MSG-01: A randomized, double-blind, placebo-controlled trial of caspofungin prophylaxis followed by preemptive therapy for invasive candidiasis in high-risk adults in the critical care setting. Clin Infect Dis. 2014; 58(9):1219-26. DOI: 10.1093/cid/ciu074. View

13.

Tacke D, Koehler P, Markiefka B, Cornely O . Our 2014 approach to mucormycosis. Mycoses. 2014; 57(9):519-24. DOI: 10.1111/myc.12203. View

14.

Dimopoulos G, Karabinis A, Samonis G, Falagas M . Candidemia in immunocompromised and immunocompetent critically ill patients: a prospective comparative study. Eur J Clin Microbiol Infect Dis. 2007; 26(6):377-84. PMC: 7101586. DOI: 10.1007/s10096-007-0316-2. View

15.

Ibrahim A, Gebermariam T, Fu Y, Lin L, Husseiny M, French S . The iron chelator deferasirox protects mice from mucormycosis through iron starvation. J Clin Invest. 2007; 117(9):2649-57. PMC: 1957543. DOI: 10.1172/JCI32338. View

16.

Agca H, Ener B, Yilmaz E, Ursavas A, Kazak E, Ozkocaman V . Comparative evaluation of galactomannan optical density indices and culture results in bronchoscopic specimens obtained from neutropenic and non-neutropenic patients. Mycoses. 2013; 57(3):169-75. DOI: 10.1111/myc.12126. View

17.

Blot S, Taccone F, Van den Abeele A, Bulpa P, Meersseman W, Brusselaers N . A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am J Respir Crit Care Med. 2012; 186(1):56-64. DOI: 10.1164/rccm.201111-1978OC. View

18.

van de Veerdonk F, Kullberg B, Netea M . Pathogenesis of invasive candidiasis. Curr Opin Crit Care. 2010; 16(5):453-9. DOI: 10.1097/MCC.0b013e32833e046e. View

19.

Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G . Invasive fungal infections in the ICU: how to approach, how to treat. Molecules. 2014; 19(1):1085-119. PMC: 6271196. DOI: 10.3390/molecules19011085. View

20.

Dimopoulos G, Tsangaris I, Poulakou G, Panayiotides J, Tsaknis G, Orfanos S . Post-operative Aspergillus mediastinitis in a man who was immunocompetent: a case report. J Med Case Rep. 2010; 4:312. PMC: 2955057. DOI: 10.1186/1752-1947-4-312. View