Fungal Infections In Intensive Care Unit Research Articles

Efficacy and Safety of Combination Antifungals as Empirical, Preemptive, and Targeted Therapies for Invasive Fungal Infections in Intensive-Care Units.

PurposeTo determine whether combinations of antifungal drugs are effective and safe for patients in intensive-care units.MethodsThis study compared the efficacy and safety of caspofungin (CAS), voriconazole (VOR), amphotericin B liposome (L-AmB), CAS+VOR, and CAS+L-AmB as empirical, preemptive, and targeted therapies for invasive fungal infection (IFI).ResultsComparing the CAS, VOR, and CAS+VOR groups revealed that there were no differences in response rates between all therapy types, IFI-associated death within 90 days was less common in the CAS+VOR group (1.8%) than the VOR group (14.3%), and there were more adverse events in the VOR group than in the CAS group (P < 0.05). For empirical or preemptive therapy, the CAS group had a better response rate (80.0%) than the CAS+VOR group (47.1%), and there were more adverse events in the VOR group than in the CAS group (P < 0.05). For targeted therapy, no differences were found for efficacy and safety. There were no differences among the CAS, L-AmB, and CAS+L-AmB groups in efficacy and safety.ConclusionPatients who received CAS monotherapy as an empirical or preemptive therapy could achieve good outcomes. Patients who received CAS+VOR or CAS+L-AmB achieved almost the same outcomes when compared with those who received CAS, VOR, and L-AmB monotherapy as targeted therapies, but those who received CAS+VOR had a lower IFI mortality rate than did those who received VOR monotherapy.

Candida Infections in Intensive Care Unit Patients: How to Diagnose?

Candida infection is a serious problem associated with increased morbidity and mortality in intensive care unit (ICU). Multiple risk factors and severe diseases make patients vulnerable to fungal infections in ICUs. Diagnosis of Candida infections should be established rapidly in order to initiate the efficient treatment early. Diagnosis of Candida infections is a very challenging […]

Epidemiology of Emerging Fungal Infections in ICU

Globally, a change has been noticed in the epidemiology of fungal infections in the intensive care units (ICUs). The current review provides an insight into the current epidemiology of emerging fungal infections with special reference to their prevalence, spectrum of pathogen, outbreaks, and emergence of antifungal resistance reported from different ICUs of the world. The ICUs across the world are witnessing multiple changes in the epidemiology of fungal infections including change in prevalence and spectrum of etiological agents, new susceptible risk groups, geographical variations, emergence of novel multi-drug resistant Candida auris, outbreak due to rare fungal species, emergence of antifungal resistance, etc. An understanding of the contemporary local epidemiology of fungal agents in ICU is essential for optimal patient management. Invasive candidiasis and invasive aspergillosis continue to haunt as major pathogens in the ICU, and several new risk factors associated with these infections have surfaced up. There is a contrasting picture for the species distribution of Candida among the different countries of the world. C. auris, the yeast behaving like bacteria, has emerged as a potential threat to ICUs across the five continents. Other mycelial agents like Mucorales, Paecilomyces spp., Fusarium spp., and Cladosporium spp., although encountered infrequently, continue to be reported as serious infections in ICU. The ICUs are also vulnerable sites for fungal infection outbreaks due to several fungi including rare ones like Cryptococcus spp., Pichia anomala, and Kodamaea ohmeri.

Changes in the distribution of colonising and infecting Candida spp. isolates, antifungal drug consumption and susceptibility in a French intensive care unit: A 10-year study.

Monitoring fungal ecology and resistance to antifungal agents within intensive care units (ICU) is essential for the management of invasive fungal infections. Therefore, a retrospective descriptive study was carried in the ICU of Nimes University Hospital, France, from 2007 to 2016. As the majority of invasive fungal infections in ICU are caused by Candida species, the study objectives were to describe Candida species distribution, to assess candidaemia incidence and to monitor the antifungal drug susceptibility of Candida isolates and the consumption of antifungal agents. Among the recorded invasive Candida infections (n=244), 43% were intra-abdominal and 22% bloodstream infections. Candida albicans was the most frequent species (55.8%), followed by Candida glabrata (14.1%), Candida tropicalis (10%), Candida parapsilosis (8%) and Candida krusei (5.3%). Candidaemia incidence was 4.49 per 1000 admissions. The mean consumption of antifungal agents was of 170.5 defined daily doses (DDD) for 1000 hospital days (HD) per year. Changes in antifungal drug consumption were observed, with an increased use of echinocandins (from 17.96 DDD/1000 HD in 2007 to 48.76 DDD/1000 HD in 2016), and the total treatment cost tripled during the study period. No significant change in fungal ecology or in the emergence of resistant species was observed; indeed, only 1.1% of isolates presented an unusual resistance to antifungal agents.