Universität zu Köln

Gloeckner, A. and Cornely, O. A. (2013). Invasive candidiasis in non-neutropenic adults. Guideline-based management in the intensive care unit. Anaesthesist, 62 (12). S. 1003 - 1010. NEW YORK: SPRINGER. ISSN 1432-055X

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Abstract

Invasive Candida infections represent a diagnostic and therapeutic challenge for clinicians particularly in the intensive care unit (ICU). Despite substantial advances in antifungal agents and treatment strategies, invasive candidiasis remains associated with a high mortality. Recent guideline recommendations on the management of invasive candidiasis by the European Society of Clinical Microbiology and Infectious Diseases (ESC-MID) from 2012, the German Speaking Mycological Society and the Paul Ehrlich Society for Chemotherapy (DMykG/PEG) from 2011 and the Infectious Diseases Society of America (IDSA) from 2009 provide valuable guidance for diagnostic procedures and treatment of these infections but need to be interpreted in the light of the individual situation of the patient and the local epidemiology of fungal pathogens. The following recommendations for management of candidemia are common to all three guidelines. Any positive blood culture for Candida indicates disseminated infection or deep organ infection and requires antifungal therapy. Treatment should be initiated as soon as possible. Removal or changing of central venous catheters or other foreign material in the bloodstream is recommended whenever possible. Ophthalmological examination for exclusion of endophthalmitis and follow-up blood cultures during therapy are also recommended. Duration of therapy should be 14 days after clearance of blood cultures and resolution of symptoms. Consideration of surgical options and a prolonged antifungal treatment (weeks to months) are required when there is organ involvement. During the last decade several new antifungal agents were introduced into clinical practice. These innovative drugs showed convincing efficacy and favorable safety in randomized clinical trials. Consequently, they were integrated in recent therapeutic guidelines, often replacing former standard drugs as first-line options. Echinocandins have emerged as the generally preferred primary treatment in candidemia. The expert panel of ESCMID views fluconazole only as a marginally recommended therapy for this indication. The use of amphotericin B deoxycholate should be generally avoided because of toxicity.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Gloeckner, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, O. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-470422
DOI:	10.1007/s00101-013-2208-4
Journal or Publication Title:	Anaesthesist
Volume:	62
Number:	12
Page Range:	S. 1003 - 1010
Date:	2013
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1432-055X
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CRITICALLY-ILL PATIENTS; ESCMID-ASTERISK GUIDELINE; BLOOD-STREAM INFECTIONS; AMPHOTERICIN-B; ATTRIBUTABLE MORTALITY; NOSOCOMIAL CANDIDEMIA; COLONIZATION; FLUCONAZOLE; DIAGNOSIS; EPIDEMIOLOGY Multiple languages Anesthesiology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/47042