Is the case for antifungal prophylaxis in the ICU now established beyong doubt? PRO
Abstract number: S189
Fungal infection are suspected in many critically ill patients who failed to respond to empirical treatment of nosocomial infections. However, if a substantial proportion of patients become colonised with Candida during ICU stay, only a minority subsequently develop an invasive candidiasis. Clinical signs of invasive candidiasis manifest only late, representing a particular challenge for diagnosis, and remains characterised by a mortality similar to septic shock (40% to 60%). An improved knowledge of the pathogenesis of candidiasis and the availability of new compounds for pre-emptive and prophylactic therapy have contributed to improve the prognosis of severe Candida infections, to the possible cost of the emergence of non-albicans Candida strains with reduced susceptibility to imidazoles. Despite growing evidence in the literature, guidelines do not integrate systematic antifungal prophylaxisfor patients at risk and empiric treatment for those who are septic with major risk factors and without documented source of infection. The Figure propose a practical approach (Adapted from: P. Eggimann, J. Garbino, D. Pittet. Management of Candida species infections in critically ill Patients Lancet Infectious Diseases 2003; 3:77285). In order to avoid exposure of patients at lower initial risk, pre-emptive antifungal treatment should be based on the combination of the presence of risk factors with the dynamics of Candida colonisation. Finally, in non-immunocompromised patients critically ill patients, prophylaxis should be strictly restricted to highly-selected groups of patients in whom it's efficacy is proven.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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