Empirical treatment of Candidaemia in intensive care units: fluconazole or broad-spectrum antifungal agents?
Abstract number: 1733_782
Guinea J., Peláez T., Torres-Narbona M., Muñoz P., Alcalá L., Bouza E.
Objectives: The fear of candidaemia by a fluconazole-resistant species of Candida is causing many ICUs to switch empiric therapy from fluconazole to broad-spectrum antifungal agents, such as amphotericin B or caspofungin. Our hypothesis was that the risk of having an episode of candidaemia or invasive candidiasis by an ``in vitro'' fluconazole-resistant strain was low and did not justify the empiric selection of broad-spectrum antifungal drugs.
Methods: We determined the species of Candida involved in episodes of invasive candidiasis and/or candidaemia in patients admitted to the three adult ICUs of our institution and evaluated the fluconazole antifungal susceptibility of each isolate. We estimated the proportion of episodes produced by fluconazole-resistant species of Candida from 1988 to 2006.
Results: 271 patients admitted to ICUs had proven invasive candidiasis or candidaemia and 520 strains were isolated from normally sterile sites from them. Candida albicans (60.9%), C. tropicalis (5.2%), C. parapsilosis (15%), and a miscellany of other species (3.7%) represented 84.8% of the isolates and were uniformly susceptible to fluconazole. Of the remaining strains, C. glabrata (13.3%) and C. krusei (1.9%) were responsible for invasive candidiasis in 38 patients, but only in nine were the isolates fluconazole-resistant in vitro (MIC ≥ 64 mg/mL). Overall, only 3.3% of the episodes of candidaemia or invasive candidiasis in our institution had an isolate resistant to fluconazole in vitro (the 6 C. krusei isolates and 3 of 32 C. glabrata isolates).
Conclusion: The generalised use of broad-spectrum antifungal agents for the empirical treatment of invasive candidiasis in ICUs may not be universally justified.
Jesús Guinea Pharm D, PhD, is contracted by the Fondo de Investigación Sanitaria (FIS), contract number CM05/00171.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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