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Clinical Aspects of Invasive Candidiasis in Critically Ill Patients

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Abstract

Invasive candidiasis has emerged as an important cause of morbidity and mortality in intensive care unit patients. This short review focuses on many aspects of Candida infection in critically ill patients including epidemiology, impact on mortality, problems related to diagnosis, strategies to identify patients at risk of developing fungal infections, role of prophylaxis and preemptive strategies, empiric treatment and the role of different classes of antifungal drugs. New antifungal agents, specifically new azoles and echinocandins are discussed.

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References

  1. Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev 2007; 20(1): 133–63

    Article  PubMed  CAS  Google Scholar 

  2. Eggimann P, Garbino J, Pittet D, et al. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis 2003; 3(11): 685–702

    Article  PubMed  Google Scholar 

  3. Pittet D, Monod M, Suter PM, et al. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 1994; 220(6): 751–8

    Article  PubMed  CAS  Google Scholar 

  4. Concia E, Azzini AM, Conti M. Epidemiology, incidence and risk factors for invasive candidiasis in high-risk patients. Drugs 2009; 69 Suppl. 1: 5–14

    Article  Google Scholar 

  5. Wey SB, Mori M, Pfaller MA, et al. Hospital-acquired candidemia: the attributable mortality and excess length of stay. Arch Intern Med 1988; 148(12): 2642–5

    Article  PubMed  CAS  Google Scholar 

  6. Gudlaugsson O, Gillespie S, Lee K, et al. Attributable mortality of nosocomial candidemia, revisited. Clin Infect Dis 2003; 37(9): 1172–7

    Article  PubMed  Google Scholar 

  7. Falagas ME, Apostolou KE, Pappas VD. Attributable mortality of candidemia: a systematic review of matched cohort and case—control studies. Eur J Clin Microbiol Infect Dis 2006; 25(7): 419–25

    Article  PubMed  CAS  Google Scholar 

  8. Leleu G, Aegerter P, Guidet B. Systemic candidiasis in intensive care units: a multicenter, matched-cohort study. J Crit Care 2002; 17(3): 168–75

    Article  PubMed  Google Scholar 

  9. Labelle AJ, Micek ST, Roubinian N, et al. Treatment-related risk factors for hospital mortality in Candida bloodstream infections. Crit Care Med 2008; 36(11): 2967–72

    Article  PubMed  Google Scholar 

  10. Reiss E, Morrison CJ. Nonculture methods for diagnosis of disseminated candidiasis. Clin Microbiol Rev 1993; 6(4): 311–23

    PubMed  CAS  Google Scholar 

  11. Morris AJ, Byrne TC, Madden JF, et al. Duration of incubation of fungal cultures. J Clin Microbiol 1996; 34(6): 1583–5

    PubMed  CAS  Google Scholar 

  12. Yera H, Sendid B, Francois N, et al. Contribution of serological tests and blood culture to the early diagnosis of systemic candidiasis. Eur J Clin Microbiol Infect Dis 2001; 20(12): 864–70

    Article  PubMed  CAS  Google Scholar 

  13. Sendid B, Poirot JL, Tabouret M, et al. Combined detection of mannanaemia and antimannan antibodies as a strategy for the diagnosis of systemic infection caused by pathogenic Candida species. J Med Microbiol 2002; 51(5): 433–42

    PubMed  CAS  Google Scholar 

  14. Mean M, Marchetti O, Calandra T. Bench-to-bedside review: Candida infections in the Intensive Care Unit. Critical Care 2008; 12(1): 204

    Article  PubMed  Google Scholar 

  15. Leon C, Ruiz-Santana S, Saavedra P, et al. A bedside scoring system (‘Candida score’) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med 2006; 34(3): 730–7

    Article  PubMed  Google Scholar 

  16. Ostrosky-Zeichner L, Sable C, Sobel J, et al. Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting. Eur J Clin Microbiol Infect Dis 2007; 26(4): 271–6

    Article  PubMed  CAS  Google Scholar 

  17. Eggimann P, Francioli P, Bille J, et al. Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients. Crit Care Med 1999; 27(6): 1066–72

    Article  PubMed  CAS  Google Scholar 

  18. 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(12): 1708–17

    Article  PubMed  Google Scholar 

  19. Pelz RK, Hendrix CW, Swoboda SM, et al. Double-blind placebo-controlled trial of fluconazole to prevent candidal infections in critically ill surgical patients. Ann Surg 2001; 233(4): 542–8

    Article  PubMed  CAS  Google Scholar 

  20. Shorr AF, Chung K, Jackson WL, et al. Fluconazole prophylaxis in critically ill surgical patients: a meta-analysis. Crit Care Med 2005; 33(9): 1928–135; quiz 36

    Article  PubMed  CAS  Google Scholar 

  21. Pappas PG, Rex JH, Sobel JD, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Disease Society of America. Clin Infect Dis 2009; 48(5): 503–35

    Article  PubMed  CAS  Google Scholar 

  22. Schuster MG, Edwards Jr JE, Sobel J, et al. Empirical fluconazole versus placebo for intensive care units patients: a randomize trial. Ann Intern Med 2008; 149(2): 83–90

    PubMed  Google Scholar 

  23. Ibrahim EH, Sherman G, Ward S, et al. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000; 118(1): 146–55

    Article  PubMed  CAS  Google Scholar 

  24. Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, et al. Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 2003; 31(12): 2742–51

    Article  PubMed  Google Scholar 

  25. Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother 2005; 49(9): 3640–5

    Article  PubMed  CAS  Google Scholar 

  26. Piarroux R, Grenouillet F, Balvay P, et al. Assessment of pre-emptive treatment to prevent severe candidiasis in critically ill surgical patients. Crit Care Med 2004; 32(12): 2443–9

    Article  PubMed  Google Scholar 

  27. 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(3): 541–7

    Article  PubMed  Google Scholar 

  28. Calandra T, Bille J, Schneider R, et al. Clinical significance of Candida isolated from peritoneum in surgical patients. Lancet 1989; 334(8677): 1437–40

    Article  Google Scholar 

  29. Blot SI, Vandewoude K, De Waele J. Candida peritonitis. Curr Opin Crit Care 2007; 13(2): 195–9

    Article  PubMed  Google Scholar 

  30. Toya SP, Schraufnagel DE, Tzelepis GE. Candiduria in intensive care units: association with heavy colonization and candidaemia. J Hosp Infect 2007; 66(3): 201–6

    Article  PubMed  CAS  Google Scholar 

  31. Chow JK, Golan Y, Ruthazer R, et al. Factors associated with candidemia caused by non-albicans Candida species versus Candida albicans in the intensive care unit. Clin Infect Dis 2008; 46(8): 1206–13

    Article  PubMed  Google Scholar 

  32. 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. N Engl J Med 1994; 331(20): 1325–30

    Article  PubMed  CAS  Google Scholar 

  33. Malani A, Hmoud J, Chiu L, et al. Candida glabrata fungemia: experience in a tertiary care center. Clin Infect Dis 2005; 41(7): 975–81

    Article  PubMed  Google Scholar 

  34. Kullberg BJ, Sobel JD, Ruhnke M, et al. Voriconazole versus a regimen of amphotericin B followed by fluconazole for candidaemia in nonneutropenic patients: a randomised noninferiority trial [see comment]. Lancet 2005; 366(9495): 1435–42

    Article  PubMed  CAS  Google Scholar 

  35. Herbrecht R, Denning DW, Patterson TF, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002; 347(6): 408–15

    Article  PubMed  CAS  Google Scholar 

  36. Kuse ER, Chetchotisakd P, da Cunha CA, et al. Micafungin versus liposomal amphotericin B for candidaemia and invasive candidosis: a phase III randomised double-blind trial. Lancet 2007; 369(9572): 1519–27

    Article  PubMed  CAS  Google Scholar 

  37. Cappelletty D, Eiselstein-McKitrick K. The echinocandins. Pharmacotherapy 2007; 27(3): 369–88

    Article  PubMed  CAS  Google Scholar 

  38. 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

    Article  PubMed  CAS  Google Scholar 

  39. Reboli AC, Rotstein C, Pappas PG, et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med 2007; 356(24): 2472–82

    Article  PubMed  CAS  Google Scholar 

  40. Sobel JD, Revankar SG. Echinocandins: first choice or firstline therapy for invasive candidiasis? N Engl J Med 2007; 356(24): 2525–6

    Article  PubMed  CAS  Google Scholar 

  41. Pfaller MA, Boyken L, Hollis RJ, et al. In vitro susceptibility of invasive isolates of Candida spp. to anidulafungin, caspofungin, and micafungin: six years of global surveillance. J Clin Microbiol 2008; 46(1): 150–6

    CAS  Google Scholar 

  42. Perlin DS. Resistance to echinocandin-class antifungal drugs. Drug Resist Update 2007; 10(3): 121–30

    Article  CAS  Google Scholar 

  43. van’t Hof W, Reijnders IM, Helmerhorst EJ, et al. Synergistic effects of low doses of histatin 5 and its analogues on amphotericin B anti-mycotic activity. Antonie Van Leeuwenhoek 2000; 78(2): 163–9

    Article  PubMed  Google Scholar 

  44. Rex JH, Pappas PG, Karchmer AW, et al. A randomized and blinded multicenter trial of high-dose fluconazole plus placebo versus fluconazole plus amphotericin B as therapy for candidemia and its consequences in nonneutropenic subjects. Clin Infect Dis 2003; 36(10): 1221–8

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

The authors thank Mary Hines of Wolters Kluwer Pharma Solutions who provided assistance with English language editing. This assistance was funded by Pfizer. Both authors have no conflicts of interest to declare.

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Correspondence to Massimo Antonelli.

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Antonelli, M., Antonelli, M. Clinical Aspects of Invasive Candidiasis in Critically Ill Patients. Drugs 69 (Suppl 1), 21–28 (2009). https://doi.org/10.2165/11315590-000000000-00000

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