Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part II. Treatment

Byline: Benoit P. Guery (1), Maiken C. Arendrup (2), Georg Auzinger (3), Elie Azoulay (4), Marcio Borges Sa (5), Elizabeth M. Johnson (6), Eckhard Muller (7), Christian Putensen (8), Coleman Rotstein (9), Gabriele Sganga (10), Mario Venditti (11), Rafael Zaragoza Crespo (12), Bart Jan Kullberg (13) Keywords: Antifungal; Azole; Candida; Candidiasis; Echinocandins; Invasive candidiasis; Intensive care; Polyenes Abstract: Background Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting particularly in the intensive care unit (ICU). Objective and methods To review the current management of invasive candidiasis and candidemia in non-neutropenic adult ICU patients based on a review of the literature and an European expert panel discussion. Results and conclusions Empiric and directed treatment for invasive candidiasis are predicated on the hemodynamic status of the patient. Unstable patients may benefit from broad-spectrum antifungal agents, which can be narrowed once the patient has stabilized and the identity of the infecting species is established. In stable patients, a more classical approach using fluconazole may be satisfactory provided that the patient is not colonized with fluconazole resistant strains or there has been recent past exposure to an azole ( Author Affiliation: (1) Infectious Diseases, SGRIVI, Hopital Huriez, CHRU Lille, 59045, Lille Cedex, France (2) Unit of Mycology, Department Bacteriology, Mycology and Parasitology, Statens Serum Institut, Building 43/117, 2300, Copenhagen, Denmark (3) Liver Intensive Care, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, UK (4) Service de Reanimation Medicale, Hopital Saint-Louis, 1, avenue Claude-Bellefaux, 75010, Paris, France (5) Sepsis Unit, Intensive Care Department, Hospital Son Llatzer, Palma de Mallorca, Spain (6) Mycology Reference Laboratory, National Collection of Pathogenic Fungi, The HPA Centre for Infections, HPA South West Laboratory, Myrtle Road, Kingsdown, Bristol, BS2 8EL, UK (7) Universitatsklinik fur Anasthesiologie, Intensivmedizin und Schmerztherapie, Knappschaftskrankenhaus Bochum, Langendreer, Klinikum der Ruhr-Universitat, In der Schornau 23--25, 44892, Bochum, Germany (8) Operative Intensivmedizin, Klinik und Poliklinik fur Anasthesiologie und Operative Intensivmedizin, Rheinische-Friedrich-Wilhelms Universitat Bonn, Sigmund-Freud Str. 25, 53127, Bonn, Germany (9) Division of Infectious Diseases, University Health Network, Toronto General Hospital, NCSB 11-1212, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada (10) Department of Surgery, Division of General Surgery and Organ Transplantation, Policlinico 'A Gemelli', Catholic University, Largo Gemelli, 8, 00168, Rome, Italy (11) Internal Medicine, Clinical Medicine Department, 'La Sapienza' University, Rome, Viale dell' Universita, 37, 00185, Rome, Italy (12) Secretario GTEI-SEMICYUC, Medicina Intensiva, Hospital Universitario Dr. Peset, Avenida Gaspa Aguilar, 90, 46107, Valencia, Spain (13) Department of Medicine (463), Nijmegen Institute for Infection, Inflammation, and Immunity (N4i), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands Article History: Registration Date: 10/10/2008 Received Date: 09/10/2008 Accepted Date: 09/10/2008 Online Date: 30/10/2008 Article note: Part I is published at: doi: 10.1007/s00134-008-1338-7. Electronic supplementary material The online version of this article (doi: 10.1007/s00134-008-1339-6) contains supplementary material, which is available to authorized users.