Prophylaxis, empirical and preemptive treatment of invasive candidiasis

Playford, EG, Lipman, J and Sorrell, TC (2010) Prophylaxis, empirical and preemptive treatment of invasive candidiasis. Current Opinion in Critical Care, 16 5: 470-474. doi:10.1097/MCC.0b013e32833e10e8


Author Playford, EG
Lipman, J
Sorrell, TC
Title Prophylaxis, empirical and preemptive treatment of invasive candidiasis
Journal name Current Opinion in Critical Care   Check publisher's open access policy
ISSN 1070-5295
1080-8183
1531-7072
Publication date 2010-10
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/MCC.0b013e32833e10e8
Volume 16
Issue 5
Start page 470
End page 474
Total pages 5
Place of publication Philadelphia, United States
Publisher Lippincott Williams & Wilkins
Collection year 2011
Language eng
Formatted abstract
Purpose of review
Invasive candidiasis remains an important infection for ICU patients, associated with
poor clinical outcomes. It has been increasingly recognized that the traditional paradigm
of culture-directed antifungal treatment is unsatisfactory, and that earlier antifungal
intervention strategies, such as prophylaxis, preemptive therapy, and empiric therapy,
are required to improve patient outcomes. The purpose of this review is to summarize
the recent supportive evidence for such strategies and to highlight the current
challenges in their implementation.
Recent findings
Despite new antifungal agents and classes, the mortality from invasive candidiasis
remains high. Antifungal prophylaxis remains the best-studied early antifungal
intervention strategy; however, unless targeted to patients at highest risk, is inefficient.
Recent data suggests that although risk predictive models, using a combination of
clinical risk factors and Candida colonization parameters, may be a relatively simple and
practical approach to guide prophylaxis or preemptive therapy, further validation of
these models is required. A single trial has demonstrated that empiric antifungal therapy
is not of benefit when instituted to patients with antibiotic-refractory fever alone.
Summary
On the basis of current knowledge, it is difficult to universally recommend antifungal
prophylaxis, apart from patient groups with a known very high risk, such as those with
necrotising pancreatitis or recurrent gastrointestinal perforations. Antifungal prophylaxis
may also be reasonable where local incidence rates and epidemiology are compelling.
Among stable patients with multifocal Candida colonization and/or a multitude of
clinical-risk factors, preemptive therapy is currently not indicated, although the
development of better risk predictive models may assist with such patients. Among
patients with refractory fever despite broad-spectrum antibacterial therapy, empiric
antifungal therapy may be reasonable where local incidence rates are high (e.g. >10%);
however, a thorough search for alternate causes must be instituted.
Copyright © Lippincott Williams & Wilkins.
Keyword Candidiasis
Fungal infection
Preemptive therapy
Prophylaxis
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2011 Collection
School of Medicine Publications
 
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Created: Sun, 26 Sep 2010, 00:07:39 EST