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High-dose fluconazole therapy in Intensive Care Unit.
P De Bellis1, M Bonfiglio, G Gerbi
1Anesthesia and Intensive Care Unit, Ospedali Galliera, Genoa, Italy. debellispasquale@fastwebnet.it
Minerva Anestesiologica
|June 7, 2003
Summary
High-dose fluconazole effectively treats invasive fungal infections in intensive care patients. This empiric treatment is well-tolerated and reduces mortality, making it a cost-effective option for high-risk individuals.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Fungal infections are a growing concern in intensive care units (ICUs).
- Morbidity and mortality associated with these infections highlight the need for effective management strategies.
- Diagnosing fungal infections like candidiasis presents clinical and laboratory challenges.
Purpose of the Study:
- To identify high-risk patients for fungal infections in the ICU.
- To evaluate the efficacy and safety of empiric, high-dose fluconazole treatment.
- To assess the impact of early intervention on patient outcomes.
Main Methods:
- A retrospective analysis of 1933 ICU patients with 1211 urine cultures.
- Empiric treatment with high-dose fluconazole (800 mg/day) was administered to 378 high-risk patients.
- Treatment duration averaged 12 days, with follow-up urine cultures.
Main Results:
- Empiric fluconazole treatment led to negative urine cultures in all patients within 1-2 weeks.
- Fluconazole was generally well-tolerated, with transient elevations in hepatic transaminases in 10% of patients.
- Severe hematogenous dissemination occurred in 6 cases; 3 patients died, with 2 deaths not directly attributed to fungal infection.
Conclusions:
- High-dose fluconazole is a less toxic, cost-effective, and effective treatment for invasive fungal infections in ICU patients.
- Empiric treatment in identified high-risk patients is crucial for successful management.
- No significant increase in antifungal resistance was observed during the study period.