CoChat
Sign Up
Cited by 41Antifungal resistance and susceptibilityNosocomial Infections in ICUOcular Infections and Treatments

Prophylaxis, empirical and preemptive treatment of invasive candidiasis

Playford, Elliott Geoffrey, Lipman, Jeff, Sorrell, Tania C·2010·Current Opinion in Critical Care
DOI 10.1097/mcc.0b013e32833e10e8
Open this paper in CoChat — free account

Abstract

PURPOSE OF REVIEW: Invasive candidiasis remains an important infection for ICU patients, associated with poor clinical outcomes. It has been increasingly recognized that the traditional paradigm of culture-directed antifungal treatment is unsatisfactory, and that earlier antifungal intervention strategies, such as prophylaxis, preemptive therapy, and empiric therapy, are required to improve patient outcomes. The purpose of this review is to summarize the recent supportive evidence for such strategies and to highlight the current challenges in their implementation. RECENT FINDINGS: Despite new antifungal agents and classes, the mortality from invasive candidiasis remains high. Antifungal prophylaxis remains the best-studied early antifungal intervention strategy; however, unless targeted to patients at highest risk, is inefficient. Recent data suggests that although risk predictive models, using a combination of clinical risk factors and Candida colonization parameters, may be a relatively simple and practical approach to guide prophylaxis or preemptive therapy, further validation of these models is required. A single trial has demonstrated that empiric antifungal therapy is not of benefit when instituted to patients with antibiotic-refractory fever alone. SUMMARY: On the basis of current knowledge, it is difficult to universally recommend antifungal prophylaxis, apart from patient groups with a known very high risk, such as those with necrotising pancreatitis or recurrent gastrointestinal perforations. Antifungal prophylaxis may also be reasonable where local incidence rates and epidemiology are compelling. Among stable patients with multifocal Candida colonization and/or a multitude of clinical-risk factors, preemptive therapy is currently not indicated, although the development of better risk predictive models may assist with such patients. Among patients with refractory fever despite broad-spectrum antibacterial therapy, empiric antifungal therapy may be reasonable where local incidence rates are high (e.g. >10%); however, a thorough search for alternate causes must be instituted.

Integrity signals

Registry

Crossref · 10.1097/mcc.0b013e32833e10e8

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A few meta-analyses have suggested potential mortality benefits with fluconazole prophylaxis; however, with an incidence of 1% to 2% in most ICU populations, more than 200 patients would need to undergo prophylaxis to prevent 1 infection.

    “A few meta-analyses have suggested potential mortality benefits with fluconazole prophylaxis; however, with an incidence of 1% to 2% in most ICU populations, more than 200 patients would need to undergo prophylaxis to prevent 1 infection.”

    From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [187]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Playford, E. G., Lipman, J., & Sorrell, T. C.
Affiliations
  • The University of Queensland (AU)
  • The University of Sydney (AU)
Corresponding author
Playford, Elliott Geoffrey
ORCID
Sorrell, Tania C
Venue
Current Opinion in Critical Care
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2010-10
Volume
16
Issue
5
Pages
470-474
ISSN
1070-5295 (ISSN-L)
DOI
10.1097/mcc.0b013e32833e10e8
OpenAlex
W2001435239
Cited by
41
References
48
Citations by year
2024: 4 · 2022: 2 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 1 · 2017: 5 · 2016: 2 · 2015: 2 · 2014: 5 · 2013: 3 · 2012: 3
FWCI
0.45
Type
journal article
Language
en
Open access
closed
Locations
  • Current Opinion in Critical Care (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
  • Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
Keywords
invasive candidiasis, antifungal prophylaxis, preemptive antifungal therapy, empirical antifungal therapy, Candida colonization, necrotizing pancreatitis, critically ill patients
MeSH terms
Antifungal Agents, Candida, Critical Care, Humans, Evidence-Based Medicine, Candidiasis, Invasive

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review