Abstract
Invasive fungal infections are a growing problem in critically ill patients and are associated with increased morbidity and mortality. Most of them are due to Candida species, especially Candida albicans. Invasive candidiasis includes candidaemia, disseminated candidiasis with deep organ involvement and chronic disseminated candidiasis. During the last decades rare pathogenic fungi, such as Aspergillus species, Zygomycetes, Fusarium speciesand Scedosporium have also emerged. Timely diagnosis and proper treatment are of paramount importance for a favorable outcome. Besides blood cultures, several laboratory tests have been developed in the hope of facilitating an earlier detection of infection. The antifungal armamentarium has also been expanded allowing a treatment choice tailored to individual patients’ needs. The physician can choose among the old class of polyenes, the older and newer azoles and the echinocandins. Factors related to patient’s clinical situation and present co-morbidities, local epidemiology data and purpose of treatment (prophylactic, pre-emptive, empiric or definitive) should be taken into account for the appropriate choice of antifungal agent.
Highlights
Great advances in contemporary medicine and especially in critical care achieved during the last decades have contributed to longer survival of patients, and to the increasing incidence of opportunistic infections caused by fungi
The purpose of the present review is to provide a practical approach to diagnosis and treatment of invasive fungal infections in the critically ill
Side effects such as anaemia, thrombocytopenia, nephrotoxicity and hepatotoxicity have been reported with LipAmB, the first two of them presenting in a dose-dependent manner [112]
Summary
Great advances in contemporary medicine and especially in critical care achieved during the last decades have contributed to longer survival of patients, and to the increasing incidence of opportunistic infections caused by fungi. Complex medical and surgical problems, disruption of natural barriers, multiple invasive procedures and prolonged antibiotic treatment are some of the factors contributing to the alarming increase of fungal infections in the Intensive Care Unit (ICU). Candidaemia is associated with a high mortality and increased length of hospital stay and cost [4,5]..High attributable mortality may be due to delayed diagnosis and treatment, development of resistance or severity of illness. The purpose of the present review is to provide a practical approach to diagnosis and treatment of invasive fungal infections in the critically ill
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