TY  - CHAP
M1  - Book, Section
TI  - Fungal Infections
A1  - Kauffman, Carol A.
A2  - Hall, Jesse B.
A2  - Schmidt, Gregory A.
A2  - Kress, John P.
PY  - 2015
T2  - Principles of Critical Care, 4e
AB  - 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.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1107720785
ER  -