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Management of Invasive Candidiasis in Critically Ill Patients

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Abstract

Candida species have become predominant pathogens in critically ill patients. In this population, invasive candidiasis is associated with a poor prognosis but adequate management can limit the attributable mortality. Adequate management, however, is hampered by a problematic diagnosis as the clinical picture of invasive disease is non-specific and blood cultures have a low sensitivity. Moreover, it is often hard to differentiate colonisation from infection and many critically ill patients are heavily colonised with Candida species, especially when receiving broad-spectrum antibacterials.

The question of which antifungal agent to choose has become more complex as the development of new drugs raises promising expectations. Until the 1980s therapy for invasive candidiasis was limited to amphotericin B, but with the advent of new antifungal agents, such as azoles and echinocandins, less toxic therapeutic options are possible and doors have opened towards prevention and optimised therapy in the case of documented candidiasis. Through the arrival of these new antifungal agents, a range of therapeutic strategies for the management of invasive candidiasis has been developed: antifungal prophylaxis, pre-emptive therapy, and empirical and definitive antifungal therapy. Each of these strategies has a specific target population, as defined by specific underlying conditions and/or individual risk factors.

Antifungal prophylaxis, in order to prevent candidal infection, is based on the type of underlying diseases with a high risk for invasive candidiasis. Individual risk factors are not taken into account. Potential indications are bone marrow transplantation, liver transplantation, recurrent gastrointestinal perforations or leakages, and surgery for acute necrotising pancreatitis. Pre-emptive therapy is also a preventive strategy. It can be recommended on the basis of an individual risk profile including overt candidal colonisation. Empirical therapy is started in patients with a risk profile for invasive candidiasis. It is recommended in the presence of clinical signs of infection, deteriorating clinical parameters, or a clinical picture of infection not responding to antibacterials but in the absence of a clear causative pathogen. Definitive antifungal therapy is defined as therapy in patients with documented invasive infection.

The main goal is to maintain a balance between optimal prevention and timely initiation of therapy on one hand, and to minimise selection pressure in order to avoid a shift towards less susceptible Candida species on the other hand.

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References

  1. Daschner F. Nosocomial infections in intensive care units. Intensive Care Med 1985; 11: 284–7

    PubMed  CAS  Google Scholar 

  2. Donowitz LG, Wenzel RP, Hoyt JW. High risk of hospital-acquired infection in the ICU patient. Crit Care Med 1982; 10: 355–7

    PubMed  CAS  Google Scholar 

  3. Schaberg DR, Culver DH, Gaynes RP. Major trends in the microbial etiology of nosocomial infection. Am J Med 1991; 91: 72S–5S

    PubMed  CAS  Google Scholar 

  4. Jarvis WR, Martone WJ. Predominant pathogens in hospital infections. J Antimicrob Chemother 1992; 29 Suppl. A: 19–24

    PubMed  Google Scholar 

  5. Holzheimer RG, Dralle H. Management of mycoses in surgical patients: review of the literature. Eur J Med Res 2002; 7: 200–26

    PubMed  Google Scholar 

  6. Dean DA, Burchard KW. Fungal infection in surgical patients. Am J Surg 1996; 171: 374–82

    PubMed  CAS  Google Scholar 

  7. Banerjee SN, Emori TG, Culver DH, et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980–1989: National Nosocomial Infections Surveillance System. Am J Med 1991; 91: 86S–9S

    PubMed  CAS  Google Scholar 

  8. Kao AS, Brandt ME, Pruitt WR, et al. The epidemiology of candidemia in two United States cities: results of a population-based active surveillance. Clin Infect Dis 1999; 29: 1164–70

    PubMed  CAS  Google Scholar 

  9. Hobson RP. The global epidemiology of invasive Candida infections: is the tide turning? J Hosp Infect 2003; 55: 159–68

    PubMed  CAS  Google Scholar 

  10. Pfaller M, Wenzel R. Impact of the changing epidemiology of fungal infections in the 1990s. Eur J Clin Microbiol Infect Dis 1992; 11: 287–91

    PubMed  CAS  Google Scholar 

  11. Sandven P, Bevanger L, Digranes A, et al. Constant low rate of fungemia in Norway, 1991 to 1996: the Norwegian Yeast Study Group. J Clin Microbiol 1998; 36: 3455–9

    PubMed  CAS  Google Scholar 

  12. Kibbler CC, Seaton S, Barnes RA, et al. Management and outcome of bloodstream infections due to Candida species in England and Wales. J Hosp Infect 2003; 54: 18–24

    PubMed  CAS  Google Scholar 

  13. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995; 274: 639–44

    CAS  Google Scholar 

  14. Voss A, le Noble JL, Verduyn Lunel FM, et al. Candidemia in intensive care unit patients: risk factors for mortality. Infection 1997; 25: 8–11

    PubMed  CAS  Google Scholar 

  15. Nolla-Salas J, Sitges-Serra A, Leon-Gil C, et al. Candidemia in non-neutropenic critically ill patients: analysis of prognostic factors and assessment of systemic antifungal therapy. Study Group of Fungal Infection in the ICU. Intensive Care Med 1997; 23: 23–30

    CAS  Google Scholar 

  16. Vincent JL, Anaissie E, Bruining H, et al. Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care. Intensive Care Med 1998; 24: 206–16

    PubMed  CAS  Google Scholar 

  17. Trick WE, Fridkin SK, Edwards JR, et al. Secular trend of hospital-acquired candidemia among intensive care unit patients in the United States during 1989–1999. Clin Infect Dis 2002; 35: 627–30

    PubMed  CAS  Google Scholar 

  18. Monitoring hospital-acquired infections to promote patient safety: United States, 1990–1999. MMWR Morb Mortal Wkly Rep 2000; 49: 149–53

    Google Scholar 

  19. Beck-Sague C, Jarvis WR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980–1990: National Nosocomial Infections Surveillance System. J Infect Dis 1993; 167: 1247–51

    PubMed  CAS  Google Scholar 

  20. Eubanks PJ, de Virgilio C, Klein S, et al. Candida sepsis in surgical patients. Am J Surg 1993; 166: 617–9

    PubMed  CAS  Google Scholar 

  21. Garbino J, Kolarova L, Rohner P, et al. Secular trends of candidemia over 12 years in adult patients at a tertiary care hospital. Medicine (Baltimore) 2002; 81: 425–33

    Google Scholar 

  22. Lipman J, Saadia R. Fungal infections in critically ill patients. BMJ 1997; 315: 266–7

    PubMed  CAS  Google Scholar 

  23. Nguyen MH, Peacock Jr JE, Morris AJ, et al. The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance. Am J Med 1996; 100: 617–23

    PubMed  CAS  Google Scholar 

  24. Blot S, Vandewoude K, Hoste E, et al. Outcome in critically ill patients with candidal fungaemia: Candida albicans vs. Candida glabrata. J Hosp Infect 2001; 47: 308–13

    CAS  Google Scholar 

  25. Marr KA, Seidel K, Slavin MA, et al. Prolonged fluconazole prophylaxis is associated with persistent protection against candidiasis-related death in allogeneic marrow transplant recipients: long-term follow-up of a randomized, placebo-controlled trial. Blood 2000; 96: 2055–61

    PubMed  CAS  Google Scholar 

  26. Marr KA, Seidel K, White TC, et al. Candidemia in allogeneic blood and marrow transplant recipients: evolution of risk factors after the adoption of prophylactic fluconazole. J Infect Dis 2000; 181: 309–16

    PubMed  CAS  Google Scholar 

  27. Slotman GJ, Shapiro E, Moffa SM. Fungal sepsis: multisite colonization versus fungemia. Am Surg 1994; 60: 107–13

    PubMed  CAS  Google Scholar 

  28. Cornwell III EE, Belzberg H, Berne TV, et al. The pattern of fungal infections in critically ill surgical patients. Am Surg 1995; 61: 847–50

    PubMed  Google Scholar 

  29. Ekenna O, Sherertz RJ, Bingham H. Natural history of bloodstream infections in a burn patient population: the importance of candidemia. Am J Infect Control 1993; 21: 189–95

    PubMed  CAS  Google Scholar 

  30. Blot SI, Vandewoude KH, Hoste EA, et al. Effects of nosocomial candidemia on outcomes of critically ill patients. Am J Med 2002; 113: 480–5

    PubMed  Google Scholar 

  31. Fraser VJ, Jones M, Dunkel J, et al. Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality. Clin Infect Dis 1992; 15: 414–21

    PubMed  CAS  Google Scholar 

  32. McKinnon PS, Goff DA, Kern JW, et al. Temporal assessment of Candida risk factors in the surgical intensive care unit. Arch Surg 2001; 136: 1401–8

    PubMed  CAS  Google Scholar 

  33. Blumberg HM, Jarvis WR, Soucie JM, et al. Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey. Clin Infect Dis 2001; 33: 177–86

    CAS  Google Scholar 

  34. Rex JH. Editorial response: catheters and candidemia. Clin Infect Dis 1996; 22: 467–70

    PubMed  CAS  Google Scholar 

  35. Wey SB, Mori M, Pfaller MA, et al. Risk factors for hospital-acquired candidemia: a matched case-control study. Arch Intern Med 1989; 149: 2349–53

    PubMed  CAS  Google Scholar 

  36. Bradley JA, Hamilton DN, Brown MW, et al. Cellular defense in critically ill surgical patients. Crit Care Med 1984; 12: 565–70

    PubMed  CAS  Google Scholar 

  37. Borzotta AP, Beardsley K. Candida infections in critically ill trauma patients: a retrospective case-control study. Arch Surg 1999; 134: 657–64

    PubMed  CAS  Google Scholar 

  38. Vanholder R, Ringoir S. Infectious morbidity and defects of phagocytic function in end-stage renal disease: a review. J Am Soc Nephrol 1993; 3: 1541–54

    PubMed  CAS  Google Scholar 

  39. Vanholder R, Van Biesen W. Incidence of infectious morbidity and mortality in dialysis patients. Blood Purif 2002; 20: 477–80

    PubMed  CAS  Google Scholar 

  40. Turner PC, Humphreys H. Hemofiltration: treating and preventing infection. Clin Microbiol Infect 1996; 2: 80–5

    PubMed  Google Scholar 

  41. Hoste E, Blot S, Lameire N, et al. Impact of nosocomial bloodstream infection on the outcome of critically ill patients with acute renal failure treated with renal replacement therapy. J Am Soc Nephrol 2004; 15: 454–62

    PubMed  Google Scholar 

  42. Takahashi K, Kita E, Konishi M, et al. Translocation model of Candida albicans in DBA-2/J mice with protein calorie malnutrition mimics hematogenous candidiasis in humans. Microb Pathog 2003; 35: 179–87

    PubMed  Google Scholar 

  43. Gianotti L, Alexander JW, Fukushima R, et al. Translocation of Candida albicans is related to the blood flow of individual intestinal villi. Circ Shock 1993; 40: 250–7

    PubMed  CAS  Google Scholar 

  44. Krause W, Matheis H, Wulf K. Fungaemia and funguria after oral administration of Candida albicans. Lancet 1969; I: 598–9

    Google Scholar 

  45. Pittet D, Monod M, Suter PM, et al. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 1994; 220: 751–8

    PubMed  CAS  Google Scholar 

  46. Bross J, Talbot GH, Maislin G, et al. Risk factors for nosocomial candidemia: a case-control study in adults without leukemia. Am J Med 1989; 87: 614–20

    PubMed  CAS  Google Scholar 

  47. Garbino J, Lew DP, Romand JA, et al. Prevention of severe Candida infections in nonneutropenic, high-risk, critically ill patients: a randomized, double-blind, placebo-controlled trial in patients treated by selective digestive decontamination. Intensive Care Med 2002; 28: 1708–17

    PubMed  Google Scholar 

  48. Eggimann P, Garbino J, Pittet D. Management of Candida species infections in critically ill patients. Lancet Infect Dis 2003; 3: 772–85

    PubMed  CAS  Google Scholar 

  49. Wey SB, Mori M, Pfaller MA, et al. Hospital-acquired candidemia: the attributable mortality and excess length of stay. Arch Intern Med 1988; 148: 2642–5

    PubMed  CAS  Google Scholar 

  50. Viudes A, Peman J, Canton E, et al. Candidemia at a tertiary-care hospital: epidemiology, treatment, clinical outcome and risk factors for death. Eur J Clin Microbiol Infect Dis 2002; 21: 767–74

    PubMed  CAS  Google Scholar 

  51. Alonso-Valle H, Acha O, Garcia-Palomo JD, et al. Candidemia in a tertiary care hospital: epidemiology and factors influencing mortality. Eur J Clin Microbiol Infect Dis 2003; 22: 254–7

    PubMed  CAS  Google Scholar 

  52. Gudlaugsson O, Gillespie S, Lee K, et al. Attributable mortality of nosocomial candidemia, revisited. Clin Infect Dis 2003; 37: 1172–7

    PubMed  Google Scholar 

  53. Michalopoulos AS, Geroulanos S, Mentzelopoulos SD. Determinants of candidemia and candidemia-related death in cardiothoracic ICU patients. Chest 2003; 124: 2244–55

    PubMed  Google Scholar 

  54. Leleu G, Aegerter P, Guidet B. Systemic candidiasis in intensive care units: a multicenter, matched-cohort study. J Crit Care 2002; 17: 168–75

    PubMed  Google Scholar 

  55. Charles PE, Doise JM, Quenot JP, et al. Candidemia in critically ill patients: difference of outcome between medical and surgical patients. Intensive Care Med 2003; 29: 2162–9

    PubMed  Google Scholar 

  56. Blot SI, Vandewoude KH. Estimating attributable mortality of candidemia: clinical judgement vs matched cohort studies. Eur J Clin Microbiol Infect Dis 2003; 22: 132–3

    PubMed  CAS  Google Scholar 

  57. Wenzel RP. The mortality of hospital-acquired bloodstream infections: need for a new vital statistic? Int J Epidemiol 1988; 17: 225–7

    PubMed  CAS  Google Scholar 

  58. Blot SI, Hoste EA, Vandewoude KH, et al. Estimates of attributable mortality of systemic Candida infection in the ICU. J Crit Care 2003; 18: 130–1

    PubMed  Google Scholar 

  59. Pappas PG, Rex JH, Lee J, et al. A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients. Clin Infect Dis 2003; 37: 634–43

    PubMed  Google Scholar 

  60. Anaissie EJ, Rex JH, Uzun O, et al. Predictors of adverse outcome in cancer patients with candidemia. Am J Med 1998; 104: 238–45

    PubMed  CAS  Google Scholar 

  61. Solomkin JS. Pathogenesis and management of Candida infection syndromes in non-neutropenic patients. New Horiz 1993; 1: 202–13

    PubMed  CAS  Google Scholar 

  62. Blot S, Vandewoude K. Early detection of systemic infections. Acta Clin Belg 2004; 59: 20–3

    PubMed  CAS  Google Scholar 

  63. Donahue SP. Intraocular candidiasis in patients with candidemia. Ophthalmology 1998; 105: 759–60

    PubMed  CAS  Google Scholar 

  64. Wingard JR. Lipid formulations of amphotericins: are you a lumper or a splitter? Clin Infect Dis 2002; 35: 891–5

    PubMed  CAS  Google Scholar 

  65. Pappas PG, Rex JH, Sobel JD, et al. Guidelines for treatment of candidiasis. Clin Infect Dis 2004; 38: 161–89

    PubMed  Google Scholar 

  66. Bekersky I, Fielding RM, Dressler DE, et al. Plasma protein binding of amphotericin B and pharmacokinetics of bound versus unbound amphotericin B after administration of intravenous liposomal amphotericin B (AmBisome) and amphotericin B deoxycholate. Antimicrob Agents Chemother 2002; 46: 834–40

    PubMed  CAS  Google Scholar 

  67. Rex JH, Bennett JE, Sugar AM, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. Candidemia Study Group and the National Institute. N Engl J Med 1994; 331: 1325–30

    CAS  Google Scholar 

  68. Voss A, de Pauw BE. High-dose fluconazole therapy in patients with severe fungal infections. Eur J Clin Microbiol Infect Dis 1999; 18: 165–74

    PubMed  CAS  Google Scholar 

  69. Duswald KH, Penk A, Pittrow L. High-dose therapy with fluconazole > or = 800mg day-1. Mycoses 1997; 40: 267–77

    PubMed  CAS  Google Scholar 

  70. Vandewoude K, Vogelaers D, Decruyenaere J, et al. Concentrations in plasma and safety of 7 days of intravenous itraconazole followed by 2 weeks of oral itraconazole solution in patients in intensive care units. Antimicrob Agents Chemother 1997; 41: 2714–8

    PubMed  CAS  Google Scholar 

  71. Kam LW, Lin JD. Management of systemic candidal infections in the intensive care unit. Am J Health Syst Pharm 2002; 59: 33–41

    PubMed  Google Scholar 

  72. Ostrosky-Zeichner L, Oude Lashof AM, Kullberg BJ, et al. Voriconazole salvage treatment of invasive candidiasis. Eur J Clin Microbiol Infect Dis 2003; 22: 651–5

    PubMed  CAS  Google Scholar 

  73. Villanueva A, Arathoon EG, Gotuzzo E, et al. A randomized double-blind study of caspofungin versus amphotericin for the treatment of candidal esophagitis. Clin Infect Dis 2001; 33: 1529–35

    PubMed  CAS  Google Scholar 

  74. Villanueva A, Gotuzzo E, Arathoon EG, et al. A randomized double-blind study of caspofungin versus fluconazole for the treatment of esophageal candidiasis. Am J Med 2002; 113: 294–9

    PubMed  CAS  Google Scholar 

  75. Arathoon EG, Gotuzzo E, Noriega LM, et al. Randomized, double-blind, multicenter study of caspofungin versus amphotericin B for treatment of oropharyngeal and esophageal candidiases. Antimicrob Agents Chemother 2002; 46: 451–7

    PubMed  CAS  Google Scholar 

  76. Mora-Duarte J, Betts R, Rotstein C, et al. Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med 2002; 347: 2020–9

    PubMed  CAS  Google Scholar 

  77. Patel R. Antifungal agents. Part I: amphotericin B preparations and flucytosine. Mayo Clin Proc 1998; 73: 1205–25

    CAS  Google Scholar 

  78. Flanagan PG, Barnes RA. Fungal infection in the intensive care unit. J Hosp Infect 1998; 38: 163–77

    PubMed  CAS  Google Scholar 

  79. Goodman JL, Winston DJ, Greenfield RA, et al. A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med 1992; 326: 845–51

    PubMed  CAS  Google Scholar 

  80. Winston DJ, Pakrasi A, Busuttil RW. Prophylactic fluconazole in liver transplant recipients: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 1999; 131: 729–37

    PubMed  CAS  Google Scholar 

  81. Eggimann P, Francioli P, Bille J, et al. Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients. Crit Care Med 1999; 27: 1066–72

    PubMed  CAS  Google Scholar 

  82. De Waele JJ, Vogelaers D, Blot S, et al. Fungal infections in patients with severe acute pancreatitis and the use of prophylactic therapy. Clin Infect Dis 2003; 37: 208–13

    PubMed  Google Scholar 

  83. Wenzel RP. Nosocomial candidemia: risk factors and attributable mortality. Clin Infect Dis 1995; 20: 1531–4

    PubMed  CAS  Google Scholar 

  84. Eggimann P, Garbino J, Pittet D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis 2003; 3: 685–702

    PubMed  Google Scholar 

  85. Chen YC, Chang SC, Luh KT, et al. Stable susceptibility of Candida blood isolates to fluconazole despite increasing use during the past 10 years. J Antimicrob Chemother 2003; 52: 71–7

    PubMed  CAS  Google Scholar 

  86. Harbarth S, Burke JP, Lloyd JF, et al. Clinical and economic outcomes of conventional amphotericin B-associated nephrotoxicity. Clin Infect Dis 2002; 35: e120–7

    PubMed  Google Scholar 

  87. Hoste EA, Lameire NH, Vanholder RC, et al. Acute renal failure in patients with sepsis in a surgical ICU: predictive factors, incidence, comorbidity, and outcome. J Am Soc Nephrol 2003; 14: 1022–30

    PubMed  Google Scholar 

  88. Hoste E, Decruyenaere J, Colardyn F. Biocompatibility and acute renal failure. Lancet 2000; 355: 312–3

    PubMed  CAS  Google Scholar 

  89. EORTC International Antimicrobial Therapy Cooperative Group. Empiric antifungal therapy in febrile granulocytopenic patients. Am J Med 1989; 86: 668–72

    Google Scholar 

  90. Walsh TJ, Finberg RW, Arndt C, et al. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. National Institute of Allergy and Infectious Diseases Mycoses Study Group. N Engl J Med 1999; 340: 764–71

    CAS  Google Scholar 

  91. Walsh TJ, Pappas P, Winston DJ, et al. Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. N Engl J Med 2002; 346: 225–34

    PubMed  CAS  Google Scholar 

  92. Johnson DC, Johnson FL, Goldman S. Preliminary results treating persistent central venous catheter infections with the antibiotic lock technique in pediatric patients. Pediatr Infect Dis J 1994; 13: 930–1

    PubMed  CAS  Google Scholar 

  93. Benoit JL, Carandang G, Sitrin M, et al. Intraluminal antibiotic treatment of central venous catheter infections in patients receiving parenteral nutrition at home. Clin Infect Dis 1995; 21: 1286–8

    PubMed  CAS  Google Scholar 

  94. Viale P, Petrosillo N, Signorini L, et al. Should lock therapy always be avoided for central venous catheter-associated fungal bloodstream infections? Clin Infect Dis 2001; 33: 1947–8

    PubMed  CAS  Google Scholar 

  95. British Society for Antimicrobial Chemotherapy Working Party. Management of deep Candida infection in surgical and intensive care unit patients. Intensive Care Med 1994; 20: 522–8

    Google Scholar 

  96. Rex JH, Bennett JE, Sugar AM, et al. Intravascular catheter exchange and duration of candidemia: NIAID Mycoses Study Group and the Candidemia Study Group. Clin Infect Dis 1995; 21: 994–6

    PubMed  CAS  Google Scholar 

  97. Oude Lashof AM, Donnelly JP, Meis JF, et al. Duration of antifungal treatment and development of delayed complications in patients with candidaemia. Eur J Clin Microbiol Infect Dis 2003; 22: 43–8

    PubMed  CAS  Google Scholar 

  98. Pierrotti LC, Baddour LM. Fungal endocarditis, 1995–2000. Chest 2002; 122: 302–10

    PubMed  Google Scholar 

  99. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 1994; 96: 200–9

    CAS  Google Scholar 

  100. Benoit D, Decruyenaere J, Vandewoude K, et al. Management of candidal thrombophlebitis of the central veins: case report and review. Clin Infect Dis 1998; 26: 393–7

    PubMed  CAS  Google Scholar 

  101. Rabinovici R, Szewczyk D, Ovadia P, et al. Candida pericarditis: clinical profile and treatment. Ann Thorac Surg 1997; 63: 1200–4

    PubMed  CAS  Google Scholar 

  102. Vikram HR, Buenconsejo J, Hasbun R, et al. Impact of valve surgery on 6-month mortality in adults with complicated, left-sided native valve endocarditis: a propensity analysis. JAMA 2003; 290: 3207–14

    PubMed  CAS  Google Scholar 

  103. Baddour LM. Long-term suppressive therapy for Candida parapsilosis-induced prosthetic valve endocarditis. Mayo Clin Proc 1995; 70: 773–5

    PubMed  CAS  Google Scholar 

  104. Johnston PG, Lee J, Domanski M, et al. Late recurrent Candida endocarditis. Chest 1991; 99: 1531–3

    PubMed  CAS  Google Scholar 

  105. Sawyer RG, Rosenlof LK, Adams RB, et al. Peritonitis into the 1990s: changing pathogens and changing strategies in the critically ill. Am Surg 1992; 58: 82–7

    PubMed  CAS  Google Scholar 

  106. Nathens AB, Rotstein OD, Marshall JC. Tertiary peritonitis: clinical features of a complex nosocomial infection. World J Surg 1998; 22: 158–63

    PubMed  CAS  Google Scholar 

  107. Rotstein OD, Pruett TL, Simmons RL. Microbiologic features and treatment of persistent peritonitis in patients in the intensive care unit. Can J Surg 1986; 29: 247–50

    PubMed  CAS  Google Scholar 

  108. Sotto A, Lefrant JY, Fabbro-Peray P, et al. Evaluation of antimicrobial therapy management of 120 consecutive patients with secondary peritonitis. J Antimicrob Chemother 2002; 50: 569–76

    PubMed  CAS  Google Scholar 

  109. Aloia T, Solomkin J, Fink AS, et al. Candida in pancreatic infection: a clinical experience. Am Surg 1994; 60: 793–6

    PubMed  CAS  Google Scholar 

  110. Sandven P, Qvist H, Skovlund E, et al. Significance of Candida recovered from intraoperative specimens in patients with intra-abdominal perforations. Crit Care Med 2002; 30: 541–7

    PubMed  Google Scholar 

  111. Sandven P, Giercksky KE. Yeast colonization in surgical patients with intra-abdominal perforations. Eur J Clin Microbiol Infect Dis 2001; 20: 475–81

    PubMed  CAS  Google Scholar 

  112. Adamson PC, Rinaldi MG, Pizzo PA, et al. Amphotericin B in the treatment of Candida cholecystitis. Pediatr Infect Dis J 1989; 8: 408–11

    PubMed  CAS  Google Scholar 

  113. Kozinin PJ, Taschdjian CL, Goldberg PK, et al. Advances in the diagnosis of renal candidiasis. J Urol 1978; 119: 184–7

    PubMed  CAS  Google Scholar 

  114. Sobel JD, Kauffman CA, McKinsey D, et al. Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis 2000; 30: 19–24

    CAS  Google Scholar 

  115. Sobel JD, Lundstrom T. Management of candiduria. Curr Urol Rep 2001; 2: 321–5

    PubMed  CAS  Google Scholar 

  116. Kontoyiannis DP, Luna MA, Samuels BI, et al. Hepatosplenic candidiasis: a manifestation of chronic disseminated candidiasis. Infect Dis Clin North Am 2000; 14: 721–39

    PubMed  CAS  Google Scholar 

  117. Walsh TJ, Whitcomb P, Piscitelli S, et al. Safety, tolerance, and pharmacokinetics of amphotericin B lipid complex in children with hepatosplenic candidiasis. Antimicrob Agents Chemother 1997; 41: 1944–8

    PubMed  CAS  Google Scholar 

  118. Walsh TJ, Whitcomb PO, Revankar SG, et al. Successful treatment of hepatosplenic candidiasis through repeated cycles of chemotherapy and neutropenia. Cancer 1995; 76: 2357–62

    PubMed  CAS  Google Scholar 

  119. Kauffman CA, Bradley SF, Ross SC, et al. Hepatosplenic candidiasis: successful treatment with fluconazole. Am J Med 1991; 91: 137–41

    PubMed  CAS  Google Scholar 

  120. Thaler M, Pastakia B, Shawker TH, et al. Hepatic candidiasis in cancer patients: the evolving picture of the syndrome. Ann Intern Med 1988; 108: 88–100

    PubMed  CAS  Google Scholar 

  121. Helton WS, Carrico CJ, Zaveruha PA, et al. Diagnosis and treatment of splenic fungal abscesses in the immune-suppressed patient. Arch Surg 1986; 121: 580–6

    PubMed  CAS  Google Scholar 

  122. Sanchez-Portocarrero J, Perez-Cecilia E, Roca V, et al. Candida albicans meningitis in 2 parenteral drug addicts: review of the literature. Enferm Infecc Microbiol Clin 1993; 11: 244–9

    PubMed  CAS  Google Scholar 

  123. Nguyen MH, Yu VL. Meningitis caused by Candida species: an emerging problem in neurosurgical patients. Clin Infect Dis 1995; 21: 323–7

    PubMed  CAS  Google Scholar 

  124. Rex JH, Walsh TJ, Sobel JD, et al. Practice guidelines for the treatment of candidiasis: Infectious Diseases Society of America. Clin Infect Dis 2000; 30: 662–78

    PubMed  CAS  Google Scholar 

  125. Saag MS, Cloud GA, Graybill JR, et al. A comparison of itraconazole versus fluconazole as maintenance therapy for AIDS-associated cryptococcal meningitis: National Institute of Allergy and Infectious Diseases Mycoses Study Group. Clin Infect Dis 1999; 28: 291–6

    PubMed  CAS  Google Scholar 

  126. Lutsar I, Roffey S, Troke P. Voriconazole concentrations in the cerebrospinal fluid and brain tissue of guinea pigs and immunocompromised patients. Clin Infect Dis 2003; 37: 728–32

    PubMed  Google Scholar 

  127. Lew TW, Darby J, Marion DW. Candida mediastinitis and septic shock following occult esophageal perforation in a patient with posttraumatic quadriplegia. J Trauma 1995; 39: 805–8

    PubMed  CAS  Google Scholar 

  128. Glower DD, Douglas Jr JM, Gaynor JW, etal. Candida mediastinitis after a cardiac operation. Ann Thorac Surg 1990; 49: 157–63

    PubMed  CAS  Google Scholar 

  129. Groll AH, Kolve H. Antifungal agents: in vitro susceptibility testing, pharmacodynamics, and prospects for combination therapy. Eur J Clin Microbiol Infect Dis 2004 Apr; 23(4): 256–70

    PubMed  CAS  Google Scholar 

  130. Vazquez JA. Combination antifungal therapy against Candida species: the new frontier — are we there yet? Med Mycol 2003; 41: 355–68

    PubMed  CAS  Google Scholar 

  131. Johnson MD, MacDougall C, Ostrosky-Zeichner L, et al. Combination antifungal therapy. Antimicrob Agents Chemother 2004; 48: 693–715

    PubMed  CAS  Google Scholar 

  132. Matthews RC, Rigg G, Hodgetts S, et al. Preclinical assessment of the efficacy of mycograb, a human recombinant antibody against fungal HSP 90. Antimicrob Agents Chemother 2003; 47: 2208–16

    PubMed  CAS  Google Scholar 

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  1. Intensive Care Department, Ghent University Hospital, De Pintelaan 185, B-9000, Gent, Belgium

    Stijn Blot & Koenraad Vandewoude

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  1. Stijn Blot
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  2. Koenraad Vandewoude
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Blot, S., Vandewoude, K. Management of Invasive Candidiasis in Critically Ill Patients. Drugs 64, 2159–2175 (2004). https://doi.org/10.2165/00003495-200464190-00002

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