Systemic candidiasis in a surgical intensive care unit.

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.