Infections fongiques en réanimation.Enquête transversale

Abstract

Study design: Diagnosis and treatment of fungal infections in medical and surgical intensive care units are controversial issues. The aim of the present survey was to assess the management of fungal infections in these units in France. Material and methods: Transversal study, by means of questionnaires, in a representative sample of French intensive care units, stratified by region and by status of the center. Results: Eighty-two out of 704 questionnaires were returned (11.6%). The distribution was as follows: academic centers (AC), 52% ; local hospitals (LH), 31% ; private centers (PC), 17%. In vitro assessment of sensitivity to antifungal drugs was done “sometimes” in 43% of the centers, “always” in 35 %. Serologic tests for Candida were performed in 63% of the cases. Antigenemia and PCR testing were nearly never performed. Only 64% of physicians always prescribed an antifungal drug in patients with candidemia (AC > LH = EP, p < 0.05). By contrast, in patients with candiduria and a urinary catheter, a treatment was more frequently thought necessary in LH and EP than in AC ( p < 0.05). Empirical treatment was more common in public (70%) than in private (36%) centers ( p < 0.05). Increasing doses of amphotericin B, without loading dose, was the generally preferred regimen (55%), and the vehicle was isotonic glucose solution (60%). The mean daily dose of fluconazole was 334 mg, after a mean loading dose of 624 mg. There was no significant differences between the centers. Conclusion: Management of fungal infections in intensive care patients appeared to be quite homogeneous, despite some discrepancies between centers about diagnostic procedures and specific indications for antifungal treatment. Attempts should be made to achieve a consensus in the setting of fungal infections.