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Published on: January 27, 2015
Systemic candidiasis in a surgical intensive care unit
Abstract:
Treatment for systemic candidiasis has often been withheld because of the nephrotoxicity of standard amphotericin B therapy, particularly in immunodepressed patients. The authors describe their experience between 1981 and 1983 with 29 such patients in the intensive care unit who were treated with low-dose amphotericin B. The diagnosis was made when endophthalmitis or persistent fungemia was present, or when Candida was cultured from three or more body sites. The daily dose of amphotericin B was 0.3 to 0.5 mg/kg. Treatment was accompanied by a mean increase in the serum creatinine value of 26% in patients who did not undergo dialysis before therapy, but this did not lead to renal failure. The overall death rate was 72.4%. Non-survival appeared to be associated with an inadequate total dosage (less than 6 mg/kg); survivors received a mean total dose of 570 mg. A retrospective analysis of positive peritoneal cultures failed to support their previously reported significance. The authors conclude that, in some instances, low-dose amphotericin B will effectively treat systemic candidiasis, resulting in little renal impairment, and that the criteria for such treatment require re-evaluation.
Insights
Low-dose amphotericin B effectively treats systemic candidiasis in intensive care patients with minimal kidney impairment. Inadequate total dosage was linked to non-survival, suggesting treatment criteria need re-evaluation.
Area of Science:
- Mycology
- Nephrology
- Critical Care Medicine
Background:
- Systemic candidiasis treatment is limited by amphotericin B's nephrotoxicity, especially in immunocompromised patients.
- Standard amphotericin B therapy poses significant renal risks, often leading to treatment withholding.
Purpose of the Study:
- To evaluate the efficacy and safety of low-dose amphotericin B for systemic candidiasis in intensive care unit (ICU) patients.
- To determine if reduced amphotericin B doses mitigate nephrotoxicity while effectively treating invasive fungal infections.
Main Methods:
- Retrospective analysis of 29 ICU patients treated with low-dose amphotericin B (0.3-0.5 mg/kg/day) between 1981 and 1983.
- Diagnosis criteria included endophthalmitis, persistent fungemia, or Candida cultured from multiple sites.
- Serum creatinine levels and overall survival rates were monitored.
Main Results:
- A mean serum creatinine increase of 26% was observed in non-dialyzed patients, without progression to renal failure.
- The overall mortality rate was high at 72.4%.
- Survival was associated with higher total amphotericin B dosage (mean 570 mg), while inadequate total dosage (<6 mg/kg) correlated with non-survival.
Conclusions:
- Low-dose amphotericin B can be an effective treatment for systemic candidiasis with acceptable renal toxicity in select ICU patients.
- Re-evaluation of treatment criteria for low-dose amphotericin B is warranted.
- Total dosage appears critical for treatment success and patient survival.
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