Management of Invasive Candidiasis and Candidemia in critically ill adults – Expert opinion of the European Society of Anaesthesia (ESA) Intensive Care scientific subcommittee

Publication date: Available online 6 December 2017 Source:Journal of Hospital Infection Author(s): Ruth-Aoibheann OLeary, Sharon Einav, Marc Leone, Krisztina Madách, Claude Martin, Ignacio Martin-Loeches Objective The global burden of invasive fungal disease is increasing. Candida albicans remains the leading cause of fungal blood stream infections although non-albicans Candidal infections are emerging. Areas of controversy regarding diagnosis and management are hampering our ability to respond effectively to this evolving threat. The purpose of this narrative review is to address current controversies and provide recommendations to supplement guidelines. Diagnosis of invasive candidiasis Diagnosis of invasive candidiasis requires a combination of diagnostic tests and patient risk factors. Beta-D Glucan and Candida albicans germ tube antibody are both used as biomarkers adjuncts to diagnosis although direct culture remains the gold standard. Scoring systems are available to help distinguish between colonisation and invasive disease. Treatment of invasive candidiasis Echinocandins are recommended as first line therapy in candidemia with de-escalation to fluconazole when clinical stability is achieved. Empirical therapy is highly recommended in high-risk patients but a more targeted pre-emptive approach is now being favoured. The evidence for prophylactic therapy remains weak. Summary Mortality attributable to invasive candidiasis may be as high as 70%. Prompt diagn...
Source: Journal of Hospital Infection - Category: Infectious Diseases Source Type: research