Update on Fungal Infections – introduction

Abstract

An international update symposium on fungal infections took place in Madrid, Spain, from 29 February to 1 March 2008. Organized by the Spanish Society of Chemotherapy and supported by the International Society of Chemotherapy, Infections and Cancer (ISC) and the Federation of European Societies for Chemotherapy and Infections (FESCI), this conference covered the epidemiological, clinical, and therapeutic aspects of the most typical settings of fungal infections in adults: the non-neutropenic critically ill patient and the immunosuppressed patient (neutropenic or undergoing solid organ transplantation [SOT] or hematopoietic stem cell transplantation [HSCT]). The significance of fungal infection in these settings has increased greatly in recent years. This is due to better intrinsic knowledge of the diseases that predispose a patient to fungal infection and the hemodynamic and nutritional support that increase survival, and also to more effective prophylaxis and antimicrobial treatment. This greater knowledge of the disease and its complications allows the choice of specific therapeutic targets (antilymphocyte monoclonal antibodies, therapy with a prolonged neutropenic effect), or prophylactic schedules that predispose the patient not just to fungal infection, but also to the selection of fungal subspecies such as non-albicans Candida, Aspergillus terreus, Scedosporium species, Zygomycetes, etc. At the conference, the main antifungal agents were reviewed in order to consolidate prophylaxis and treatment schedules. The guidelines of the Infectious Disease Society of America (IDSA) [1] were taken as a reference for invasive candidiasis and aspergillosis [2], with specific considerations according to the model of infection and the patient’s profile. A change in the frequency and type of yeast isolates has emerged in intensive care units [3]. The current incidence of candidemia is around 1.5 episodes per 1000 days of intensive care unit (ICU) admission, with an attributable