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  • Candida species are the third most frequent cause of bloodstream infections in ICUs in US hospitals and are responsible for 10% of nosocomial infections in some European ICUs.

  • Candida albicans is the most common cause of candidemia in ICU patients. In the last two decades in the United States, there has been a shift upward in the proportion of candidemias that are caused by other Candida species, especially Candida glabrata. The prominent Candida species in many neonatal ICUs is Candida parapsilosis.

  • The risk factors for invasive candidiasis include extremes of age, trauma, burns, high APACHE II score, recent abdominal surgery, gastrointestinal tract perforation, pancreatitis, mechanical ventilation, central venous catheters, parenteral nutrition, dialysis, and broad-spectrum antibiotic therapy.

  • Candiduria is common in the ICU and is mostly related to the presence of indwelling bladder catheters and broad-spectrum antimicrobial agents. The vast majority of patients who are candiduric are colonized, do not develop upper tract infection or candidemia, and do not require treatment.

  • All patients who have documented candidemia should have a dilated eye examination by an ophthalmologist to determine whether metastatic infection is present in the eye.

  • All patients with documented candidemia should be treated with an antifungal agent. Prompt treatment of candidemia significantly decreases the mortality rate, and delay for 24 hours or more after the blood culture is taken is associated with increased mortality.

  • In an ICU in which C glabrata is a commonly isolated organism, initial treatment should be with an echinocandin. If the ICU historically has had few infections caused by C glabrata, initial treatment shoud be with fluconazole. After the organism has been identified, therapy should be switched to the most appropriate agent.

  • Removal of central venous catheters in patients with candidemia leads to more rapid clearing of the organism from blood and improved outcomes.

  • Prophylaxis against invasive candidiasis with fluconazole could be considered in ICUs that have rates of candidemia that exceed 10%; it should not be used in most ICUs.


Invasive fungal infections are an increasingly prevalent problem in hospitalized patients, especially those in intensive care units (ICU).1-9Candida species cause more than 90% of fungal infections in the ICU setting. Candida species are the third most frequent cause of bloodstream infections in ICUs in US hospitals and are responsible for 10% of nosocomial infections in some European ICUs.1,4 The reasons for the increase in invasive Candida infections in ICU patients include the expanding numbers of immunocompromised patients, longer survival in the ICU of patients who have multiple medical problems, increased use of devices and invasive procedures that disrupt the host’s natural barriers to infection, and the adverse effects of broad-spectrum antimicrobial agents on the normal human microbiota.

Far less frequent are infections due to Aspergillus species, but there are increasing reports of invasive aspergillosis in nonneutropenic patients in the ICU.10,11 Occasional patients who have ...

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