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Antifungal therapy and its use in surgical treatment
1Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Abstract:
Modern surgery continues to make significant therapeutic advances, and a major component in the adjunctive care allowing these improved procedures is the successful use of broad-spectrum antibacterials. However, the widespread administration of potent antibacterials and the frequent use of a variety of catheters, along with an increase in the number of immune compromised patients requiring invasive procedures, have allowed deep-seated mycoses to become more common. Nosocomial fungal infections are frequent, particularly in the urinary tract and in the blood. This rise in identified fungal infections, along with frequent empiric treatment of suspected infection, has significantly increased amphotericin B therapy in surgical services in the last five years. While amphotericin B remains the standard for treatment of nosocomial mycoses, other antifungal agents are available (flucytosine, miconazole, ketoconazole and fluconazole). Despite experience with the older agents and the development of new agents, many questions remain concerning the use of currently available antifungal treatments in postsurgical patients. The following discussion attempts to summarize the magnitude of the problem, the difficulties with diagnosis and laboratory evaluations, the characteristics of the antifungal agents and particular problems with antifungal treatment in surgery.
Insights
Deep-seated fungal infections are increasing in surgical patients due to broad-spectrum antibacterial use and invasive procedures. This review discusses antifungal treatments for these challenging nosocomial mycoses.
Area of Science:
- Surgical Infectious Diseases
- Mycology
- Pharmacology
Background:
- Advances in surgery are supported by broad-spectrum antibacterials, but this has led to an increase in deep-seated fungal infections.
- Nosocomial fungal infections, particularly in the urinary tract and bloodstream, are becoming more prevalent in surgical settings.
- Increased use of catheters and a rise in immunocompromised patients undergoing invasive procedures contribute to this trend.
Purpose of the Study:
- To summarize the challenges of fungal infections in postsurgical patients.
- To review diagnostic and laboratory evaluation difficulties.
- To discuss characteristics of antifungal agents and their specific issues in surgical contexts.
Main Methods:
- Literature review and synthesis of existing data on antifungal treatments in surgical patients.
- Analysis of the prevalence and types of nosocomial fungal infections.
- Evaluation of current and emerging antifungal agents, including amphotericin B, flucytosine, miconazole, ketoconazole, and fluconazole.
Main Results:
- Amphotericin B remains the standard treatment for nosocomial mycoses.
- Several other antifungal agents are available, but their use in postsurgical patients presents unique challenges.
- Diagnosis and laboratory evaluation of fungal infections in surgical settings can be difficult.
Conclusions:
- The rising incidence of fungal infections in surgical patients necessitates a thorough understanding of available antifungal treatments.
- Further research is needed to address specific problems with antifungal therapy in the postsurgical population.
- Optimizing antifungal strategies is crucial for improving outcomes in surgical patients with mycoses.