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Untargeted Antifungal Treatment Strategies for Invasive Candidiasis in Non-neutropenic Critically Ill Patients: Current Evidence and Insights

  • Current Management of Fungal Infections (M Miceli, Section Editor)
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Abstract

Purpose of Review

The purpose of this study was to provide an overview and insights on important new concepts on untargeted antifungal treatment strategies, namely prophylaxis pre-emptive and empiric treatments for the management of invasive candidiasis (IC) in non-neutropenic critically ill patients.

Recent Findings

Recently, clinical practice guidelines provided recommendation for the management of IC. However, results from recent trials and systematic reviews questioned the effect of untargeted antifungal treatment strategies, especially in terms of survival benefits in non-neutropenic patients, even with septic shock.

Summary

Widespread use of untargeted antifungal treatment strategies seems not to be justified anymore. Future research should evaluate comprehensive diagnostic-therapeutic approaches, including the implementation of de-escalation. In the meanwhile, clinicians should take into account all available sources of information including clinical evaluation, risk factor assessment, scores, and surrogate biomarkers to tailor antifungal treatment before definitive microbiological diagnosis.

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Authors and Affiliations

  1. Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anesthesia Analgesia, Intensive Care, and Emergency, .Policlinico P. Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy

    Andrea Cortegiani, Vincenzo Russotto, Santi Maurizio Raineri, Cesare Gregoretti & Antonino Giarratano

  2. Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anesthesia, Analgesia, Intensive Care, and Emergency, University of Palermo, Turin, Italy

    Francesco Giuseppe De Rosa

Authors
  1. Andrea Cortegiani
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  2. Vincenzo Russotto
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  3. Santi Maurizio Raineri
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  4. Cesare Gregoretti
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  5. Francesco Giuseppe De Rosa
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  6. Antonino Giarratano
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Correspondence to Andrea Cortegiani.

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This article is part of the Topical Collection on Current Management of Fungal Infections

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Cortegiani, A., Russotto, V., Raineri, S.M. et al. Untargeted Antifungal Treatment Strategies for Invasive Candidiasis in Non-neutropenic Critically Ill Patients: Current Evidence and Insights. Curr Fungal Infect Rep 11, 84–91 (2017). https://doi.org/10.1007/s12281-017-0288-3

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