Treatment of fungal infections in surgical patients using conventional antifungals

Area of Science:

• Infectious Diseases
• Mycology
• Critical Care Medicine

Background:

• Rising incidence of invasive fungal infections observed in surgical and intensive care units.
• Increased risk factors include patient transfers from hemato-oncological/transplant units and use of immunosuppressants like corticosteroids.
• Candida species are now common pathogens in critically ill patients.

Purpose of the Study:

• To review current therapeutic options for invasive fungal infections, particularly candidosis.
• To evaluate the efficacy and toxicity of different antifungal agents.
• To discuss the role of central venous catheter management and alternative therapies for invasive mycoses.

Main Methods:

• Review of existing literature on invasive fungal infections and their treatment.
• Comparison of standard therapy (Amphotericin B) with newer agents (lipid formulations, fluconazole).
• Analysis of data regarding central venous catheter removal and outcomes in candidemia.

Main Results:

• Lipid formulations and fluconazole demonstrate comparable response rates to Amphotericin B for candidosis with potentially less toxicity.
• Evidence regarding the benefit of prompt central venous catheter removal in candidemia is conflicting.
• Amphotericin B remains standard for other invasive mycoses, but dose limitations necessitate exploring alternatives like triazoles and liposomal preparations.

Conclusions:

• Antifungal treatment strategies for invasive mycoses require careful consideration of drug efficacy, toxicity, and patient-specific factors.
• Further research is needed to clarify the role of interventions like central venous catheter removal.
• Exploration of triazoles and liposomal preparations is crucial for managing invasive mycoses where standard therapy is limited.