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Antifungal Therapy in The ICU: The Bug, the Drug, and the Mug

  • Chapter
Annual Update in Intensive Care and Emergency Medicine 2011

Part of the book series: Annual Update in Intensive Care and Emergency Medicine 2011 ((AUICEM,volume 1))

Abstract

The incidence of invasive fungal infections has increased steadily, namely due to the increasing number of immunocompromised and critically ill patients. Candida spp. is by far the most frequent fungal pathogen isolated in critically ill patients, accounting for more than 85 % of fungal infections. Intensive care candidiasis represents 25 – 50 % of all invasive candidiasis. The incidence of candidemia, although rather variable from unit to unit, ranging from 2.8 to 22 per 10 000 patient days, is tenfold higher in the intensive care unit (ICU) than in the wards and Candida species are responsible for around 10 % of all ICU-acquired infections worldwide. In the recent Sepsis Occurrence in Acutely ill Patients (SOAP) study, Candida spp. accounted for 17 % of all cases of sepsis in the ICU and for 20 % of all ICU-acquired sepsis [1]. In the large, multicenter Extended Prevalence of Infection in the ICU (EPIC II) study, fungi were responsible for 20 % of all microbiologically documented infections and Candida spp. was the main fungal pathogen (17 %) [2]. However, previously uncommon or even new fungal pathogens are increasing in the ICU, namely Aspergillus spp. (mainly Aspergillus fumigatus), Zygomycetes (mainly Mucor and Rhizopus) and Fusarium. In recent years, several reports have described an increasing incidence of invasive pulmonary aspergillosis in critically ill patients admitted to the ICU, even in the absence of an apparent predisposing immunodeficiency, such as neutropenia or hematologic malignancy. Factors like the use of steroids, chronic obstructive pulmonary disease (COPD) and chronic liver failure seem to be associated with the development of invasive pulmonary aspergillosis in the ICU, whose incidence ranges from 0.3 % to as much as 5.8 % [3]–[5].

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Authors and Affiliations

  1. Intensive Care Department, Hospital S. Joao, 4200, Porto, Portugal

    J. M. Pereira

  2. Emergency and Intensive Care Department, Hospital S. Joao, 4200, Porto, Portugal

    J. A. Paiva

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  1. Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Head) (Head)

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Pereira, J.M., Paiva, J.A. (2011). Antifungal Therapy in The ICU: The Bug, the Drug, and the Mug. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2011. Annual Update in Intensive Care and Emergency Medicine 2011, vol 1. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-18081-1_47

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