Antifungal therapies in the intensive care unit

Fungal infections are increasing nationwide, paralleling increases in the number of immunosuppressed hosts. Most of the candida infections seen in the intensive care unit are likely due to iatrogenic factors such as hyperalimentation, catheters, broad-spectrum antibiotics, and postprocedure complications that are prevalent in intensive care unit patients. Delays in appropriate therapy are common and may compromise care. Fortunately, the recognition of several clinical syndromes in the intensive care unit that require specialized treatment can improve outcomes. The issue of antifungal prophylaxis has to be balanced against issues of resistance, and current guidelines are reviewed here for prophylactic use of fluconazole only in selected intensive care unit patients. Finally, several new antifungal agents are available to treat the emerging resistant fungi, with better toxic/therapeutic ratios than in the past. Thus, there are an increasing number of safer and more effective options for treating fungal infections in the intensive care unit.