Management of Candidiasis in Critically Ill Patients

2002 ◽  
Vol 15 (2) ◽  
pp. 106-113
Author(s):  
Manjunath P. Pai ◽  
Larry H. Danziger ◽  
Susan L. Pendland
Keyword(s):  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Economic Consequences ◽  
Drug Selection ◽  
Testing Method ◽  
Candida Infections

Fungal infections have been increasing at an alarming rate in critically ill patients. Candida is now the fourth most common pathogen isolated from the bloodstream and is associated with significant morbidity, mortality, and economic consequences. Novel antifungals have been developed in recent years to provide alternatives to amphotericin B, which continues to be the standard therapy for most invasive fungal infections. These alternatives include lipid-based amphotericin B, ketoconazole, fluconazole, itraconazole, caspofungin, and potentially voriconazole. Optimal therapy for the various forms of candidiasis remains controversial. A standardized antifungal susceptibility testing method for Candida isolates has been developed to assist drug selection, but its clinical relevance remains to be determined. The relative susceptibility of Candida isolates can be estimated by the species. Specifically, C krusei is resistant to azoles, C glabrata may be resistant to azoles, and C lusitaniae may be resistant to amphotericin B Candida infections can affect any organ system, and the diagnosis of such infections remains difficult. The Infectious Diseases Society of America recently developed guidelines for the management of candidiasis. This review includes a brief discussion of systemically administered antifungal agents and provides a synopsis of the practice guidelines for the management of candidiasis.

scholarly journals Distribution and antifungal susceptibility of Candida species in patients with increased risk for fungal infections

2016 ◽  
Vol 62 (1) ◽  
pp. 65-76
Author(s):  
Gordana Mirchevska ◽  
Maja Jurhar Pavlova ◽  
Elena Trajkovska-Dokic ◽  
Zaklina Cekovska ◽  
Gordana Jankoska ◽  
...  
Keyword(s):  
Blood Culture ◽  
Amphotericin B ◽  
Critically Ill Patients ◽  
Candida Species ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Clinical Specimens ◽  
Fourth Group ◽  
Increased Risk

Candida species are opportunistic yeasts that can be a serious threat for immunocompromised and critically ill patients, and a cause for increased morbidity and mortality in hospitalized patients. The aim of this study was to determine the frequency and distribution of different Candida species in clinical specimens in patients with increased risk for fungal infections, and to determine the antifungal susceptibility profile of invasive Candida species to antifungal agents. During a two year period, clinical specimens from 120 patients divided into 4 groups were analysed at the Institute of microbiology and parasitology, Faculty of Medicine, Skopje, Republic of Macedonia. Each of these 4 groups consisted of specimens from 30 patients, with primary immune deficiency, critically ill patients treated in the intensive care units (ICU), patients with mucosal candidiasis only, and patients with cystic fibrosis. All specimens were investigated with conventional mycological methods. Identification of Candida species was performed with VITEK-2 system (bioMérieux, France). E-test strips of fluconazole, voriconazole, amphotericin B and caspofungin (AB bioMerieux, France) were used for determination of the antifungal susceptibility profile. In this study, a total of 115 isolates of Candida species were confirmed in different clinical specimens (91 isolates from mucosal surfaces and 24 isolates from blood culture). Colonisation of mucosal membranes of gastrointestinal, respiratory and/or urinary tracts was registered in 56.67% (17/30), 56.67% (17/30), 90% (27/30) and 100% (30/30) of the specimens in the first, second, third and fourth group respectively. In all four groups of patients, the following Candida species were confirmed: C. albicans - 55%, C. glabrata - 17.6%, C. parapsilosis - 7.7%, C. tropicalis - 6.6%, unidentified Candida species - 4.4%, C. dubliniensis - 3.3%, C. kefyr - 2.2%, and one isolate of C. rugosa, C. pelliculosa and C. krusei each. Positive blood culture was registered in 23.33% specimens from the first group, 43.33% in the second group, 23.08% of the third group, and in one specimen of the fourth group. The most frequent isolates from blood culture were C. tropicalis and C. krusei, followed by C. albicans, C. parapsilosis and C. tropicalis, and in the second group C. albicans and C. pelliculosa were equally distributed, followed by C. parapsilosis and C. glabrata. All invasive isolates of Candida species were susceptible to amphotericin B, voriconazole and caspofungin. Resistance to fluconazole was registered in 8.3% (2/24) of all confirmed Candida species. Dose-dependent susceptibility to fluconazole was confirmed in 46% (11/24) of the isolates. Our study confirms high prevalence of colonisation and candidemia with non-albicans Candida species. Resistance to antifungal agents was registered only in two isolates of C. krusei. An epidemiological study is necessary for surveillance of dynamics of candidemia and antifungal susceptibility profile of invasive isolates of Candida species in our patients.

Systemic Antifungal Agents

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Antifungal Prophylaxis ◽  
Morbidity And Mortality ◽  
Transplant Recipients ◽  
Therapeutic Approaches ◽  
Timely Fashion ◽  
Antifungal Chemotherapy

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Despite the development of a number of new and useful antifungal agents in the past decade and the noteworthy improvements in therapeutic approaches to fungal infections, physicians’ ability to diagnose these infections in a timely fashion remains limited, and patient outcomes remain poor. Antifungal prophylaxis has emerged as a potential means of reducing the occurrence of serious fungal infections. In patient populations estimated to be at high risk for acquiring a fungal infection, antifungal prophylaxis has reduced infection rates by about 50%; however, it has not been shown to significantly improve mortality. This review discusses both established and newly approved systemic antifungal agents. Tables list characteristics of currently available antifungals and antifungal chemotherapy. This review contains 2 tables and 32 references Key words: antifungal chemotherapy, antifungal prophylaxis, antifungals, Candida prophylaxis, systemic antifungal medications

Candidiasis

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antimicrobial Agents ◽  
Fungal Infections ◽  
Diagnostic Methods ◽  
Ventricular Assist Devices ◽  
Transplant Recipients ◽  
Ventricular Assist ◽  
Disseminated Candidiasis ◽  
Candida Infections

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Over the past few decades, technological and scientific advancements have improved physicians’ ability to sustain life in critically ill patients; developments in chemotherapeutics and immune-based therapies have yielded increased survival for many cancer patients; organ transplantation has evolved dramatically; and the use of invasive therapies (eg, ventricular assist devices) has increased markedly. With these changes has come an increase in the incidence of serious Candida infections. This review covers the definition and classification, epidemiology and risk factors, and clinical evaluation of candidiasis, as well as management of candidemia, acute disseminated candidiasis, nonhematogenous candidiasis, and peritonitis and intra-abdominal abscess. Figures show Candida endophthalmitis in patients with persistent fungemia and superficial candidiasis in the gastrointestinal tract. Tables list clinical presentation and diagnostic methods for common fungal infections, antimicrobial agents of choice for candidal infections, and the latest guidelines for candidiasis. This review contains 2 figures, 3 tables and 131 references Key words: acute disseminated candidiasis, candidemia, candidiasis, candiduria, nonhematogenous candidiasis  

scholarly journals Antifungal agents for preventing fungal infections in non-neutropenic critically ill patients

2006 ◽  
Author(s):  
Elliott Geoffrey Playford ◽  
Angela C Webster ◽  
Tania C Sorrell ◽  
Jonathan C Craig
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antifungal Agents ◽  
Fungal Infections

Fungal Infections

2013 ◽  
Author(s):  
Sara Buckman ◽  
Luis A. Fernandez
Keyword(s):  
Fungal Infection ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Antimicrobial Agents ◽  
Fungal Infections ◽  
Antifungal Prophylaxis ◽  
Diagnostic Methods ◽  
Fungal Colonization ◽  
Surgical Patient ◽  
Candida Infections

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant patients, and sick neonates all being especially vulnerable. Over the past few decades, technological and scientific advancements have improved physicians’ ability to sustain life in critically ill patients, developments in chemotherapeutics and immune-based therapies have yielded increased survival for many cancer patients, organ transplantation has evolved dramatically, and the use of invasive therapies has increased markedly. With these changes has come an increase in the incidence of serious Candida infections, as well as an increase in the less common but potentially fatal noncandidal infections caused by Aspergillus and the Zygomycetes Mucor and Rhizopus. Antifungal prophylaxis has emerged as a potential means of reducing the occurrence of serious fungal infections. This review covers fungal colonization versus infection, types of fungal infection, epidemiology and risk factors, clinical evaluation, investigative studies, management of acute candidemia and acute disseminated candidiasis, management of nonhematogenous candidiasis, peritonitis and intra-abdominal abscess, management of other fungal infections (Aspergillus, Cryptococcus, Mucor, Rhizopusi), systemic antifungal agents, and the pathogenesis of Candida infection. Tables describe the clinical presentation and diagnostic methods for common fungal infections, antimicrobial agents of choice for candida infections, antifungal chemotherapy, and characteristics of currently available antifungals. Figures show Candida endophthalmitis; superficial candidiasis; biopsy samples of chronic progressive disseminated histoplasmosis and thick-walled, broad-based budding yeasts typical for Blastomyces dermatitidis; and the various forms of Candida. Algorithms demonstrate the approach to the surgical patient at risk for candidiasis, aspergillosis, and other types of fungal infection. This review contains 5 figures, 4 tables, and 189 references.

scholarly journals Optimal management of acute kidney injury in critically ill patients with invasive fungal infections being treated with liposomal amphotericin B

2020 ◽  
Vol 13 (5) ◽  
pp. e233072 ◽  
Author(s):  
Darius Armstrong-James ◽  
Mickey Koh ◽  
Marlies Ostermann ◽  
Paul Cockwell
Keyword(s):  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Kidney Injury ◽  
Invasive Fungal Infections ◽  
Liposomal Amphotericin B ◽  
Cell Transplant

Critically ill patients are at risk of developing both acute kidney injury (AKI) and invasive fungal infections (IFIs). Prompt and efficient treatment of the IFI is essential for the survival of the patient. This article examines three distinct clinical situations where liposomal amphotericin B, a broad-spectrum antifungal agent, was successfully used in the setting of AKI. The first was Aspergillus infection in a 63-year-old man with bleeding oesophageal varices related to advanced liver disease. The second was gastrointestinal mucormycosis in a 74-year-old man who developed a small bowel obstruction following an autologous stem cell transplant for mantle cell lymphoma. The third was a Fusarium infection in a 32-year-old woman on immunosuppression for a bilateral lung transplant for cystic fibrosis. In all three cases, liposomal amphotericin B was required for urgent management of the patient’s IFI. We discuss the rationale for treatment with a potentially nephrotoxic agent in this setting.

Genotyping and Antifungal Vulnerability of Candida albicans Isolated from Cancer Patients in Dewaniyeh Governorate.

2018 ◽  
Vol 1 (3) ◽  
pp. 43-51
Author(s):  
Radhi F Shalash ◽  
Adnan Al-Hamdani
Keyword(s):  
Cancer Patients ◽  
Amphotericin B ◽  
Antifungal Agents ◽  
Antifungal Susceptibility ◽  
High Rate ◽  
Pcr Analysis ◽  
Predominant Genotype ◽  
Candida Infections ◽  
25S Rdna ◽  
Genotype A

Background: Candida infections are one of the major causes of morbidity in cancer patients. Aim: To determine the genotype and antifungal susceptibility of C. albicans isolated from cancer patients and compared with that from healthy individuals. Materials and methods: Oral swabs collected from cancer patients and healthy subjects were screened for the occurrence of C. albicans. Isolates were identified to species level by the conventional mycological methods. Genotypes were determined with use of 25S rDNA PCR analysis. Susceptibility testing was performed using HiCombo MIC technique. Results: Phenotypic examination showed that oral C. albicans was detected in 90% of cancer patients and 50% of healthy controls. PCR shows that the isolates of A, B, C and T genotypes, among which genotype A C. albicans was the predominant genotype. Genotype A C. albicans recognized the entirely isolates in healthy group. Isolates were most sensitive to amphotericin B. Occurrence of resistance to amphotericin B was the lowest followed by itraconazole. However, the isolates demonstrated a high rate of resistance to ketoconazole and fluconazole. Conclusion: Based on these results, 25S rDNA have been shown to be a useful criterion for distinguishing among various isolates of C. albicans. Amphotericin B is effective antifungal agents that can be used against isolates.

Systemic Antifungal Agents

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Antifungal Prophylaxis ◽  
Morbidity And Mortality ◽  
Transplant Recipients ◽  
Therapeutic Approaches ◽  
Timely Fashion ◽  
Antifungal Chemotherapy

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Despite the development of a number of new and useful antifungal agents in the past decade and the noteworthy improvements in therapeutic approaches to fungal infections, physicians’ ability to diagnose these infections in a timely fashion remains limited, and patient outcomes remain poor. Antifungal prophylaxis has emerged as a potential means of reducing the occurrence of serious fungal infections. In patient populations estimated to be at high risk for acquiring a fungal infection, antifungal prophylaxis has reduced infection rates by about 50%; however, it has not been shown to significantly improve mortality. This review discusses both established and newly approved systemic antifungal agents. Tables list characteristics of currently available antifungals and antifungal chemotherapy. This review contains 2 tables and 32 references Key words: antifungal chemotherapy, antifungal prophylaxis, antifungals, Candida prophylaxis, systemic antifungal medications

Candidiasis

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antimicrobial Agents ◽  
Fungal Infections ◽  
Diagnostic Methods ◽  
Ventricular Assist Devices ◽  
Transplant Recipients ◽  
Ventricular Assist ◽  
Disseminated Candidiasis ◽  
Candida Infections

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Over the past few decades, technological and scientific advancements have improved physicians’ ability to sustain life in critically ill patients; developments in chemotherapeutics and immune-based therapies have yielded increased survival for many cancer patients; organ transplantation has evolved dramatically; and the use of invasive therapies (eg, ventricular assist devices) has increased markedly. With these changes has come an increase in the incidence of serious Candida infections. This review covers the definition and classification, epidemiology and risk factors, and clinical evaluation of candidiasis, as well as management of candidemia, acute disseminated candidiasis, nonhematogenous candidiasis, and peritonitis and intra-abdominal abscess. Figures show Candida endophthalmitis in patients with persistent fungemia and superficial candidiasis in the gastrointestinal tract. Tables list clinical presentation and diagnostic methods for common fungal infections, antimicrobial agents of choice for candidal infections, and the latest guidelines for candidiasis. This review contains 2 figures, 3 tables and 131 references Key words: acute disseminated candidiasis, candidemia, candidiasis, candiduria, nonhematogenous candidiasis  

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