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Published on: July 1, 2020
Increasing fungal infections in the intensive care unit
1Department of Blood Transfusion Service and Transplant Immunology, University Medical Center St. Radboud, Nijmegen, The Netherlands. b.depauw@abti.umcn.n
Background:
Yeasts and molds now rank among the most common pathogens in intensive care units. Whereas the incidence of Candida infections peaked in the late 1970s, aspergillosis is still increasing.
Method:
Review of the pertinent English-language literature.
Results:
Most factors promoting an invasive fungal infection are difficult to avoid because they are connected directly to treatment of the underlying disease. Antifungal treatment is often commenced on an empiric basis, whereas it might be preferable to adopt a strategy based on a diagnostic procedure able to demonstrate or exclude fungal disease. Polyenes have been the drugs of choice, but voriconazole is the new standard for aspergillosis. For invasive candidiasis, fluconazole is a more convenient option, with the new echinocandins or voriconazole as alternatives.
Conclusions:
The incidence of invasive fungal infection is increasing, but so too are the choices of agents for therapy. For reasons of efficacy and safety, therapy with an echinocandin or azole antifungal agent is supplanting the use of polyenes.
Insights
Invasive fungal infections from yeasts and molds are rising in ICUs. Newer antifungal agents like azoles and echinocandins offer improved efficacy and safety over older polyenes.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Critical Care Medicine
Background:
- Yeasts and molds are increasingly common pathogens in intensive care units (ICUs).
- While Candida infections peaked previously, aspergillosis incidence continues to rise.
Purpose of the Study:
- To review current trends and therapeutic options for invasive fungal infections in ICUs.
- To compare the efficacy and safety of different antifungal agents.
Main Methods:
- A review of the relevant English-language medical literature was conducted.
Main Results:
- Risk factors for invasive fungal infections are often linked to underlying disease treatments.
- Empiric antifungal therapy is common, but diagnostic strategies are preferred.
- Voriconazole is the standard for aspergillosis; fluconazole is convenient for candidiasis, with echinocandins as alternatives.
Conclusions:
- Invasive fungal infections are increasing, alongside a growing array of therapeutic agents.
- Echinocandin and azole antifungals are replacing polyenes due to better efficacy and safety profiles.
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