RESUMO
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been sweeping across the globe. Based on a retrospective analysis of SARS and influenza data from China and worldwide, we surmise that the fungal co-infections associated with global COVID-19 might be missed or misdiagnosed. Although there are few publications, COVID-19 patients, especially severely ill or immunocompromised, have a higher probability of suffering from invasive mycoses. Aspergillus and Candida infections in COVID-19 patients will require early detection by a comprehensive diagnostic intervention (histopathology, direct microscopic examination, culture, (1,3)-ß-D-glucan, galactomannan, and PCR-based assays) to ensure effective treatments. We suggest it is prudent to assess the risk factors, the types of invasive mycosis, the strengths and limitations of diagnostic methods, clinical settings, and the need for standard or individualized treatment in COVID-19 patients. We provide a clinical flow diagram to assist the clinicians and laboratory experts in the management of aspergillosis, candidiasis, mucormycosis, or cryptococcosis as co-morbidities in COVID-19 patients.
Assuntos
Infecções por Coronavirus/complicações , Micoses/complicações , Pneumonia Viral/complicações , COVID-19 , Candidíase Invasiva/complicações , Candidíase Invasiva/diagnóstico , Candidíase Invasiva/terapia , China , Infecções por Coronavirus/diagnóstico , Criptococose/complicações , Criptococose/diagnóstico , Criptococose/terapia , Humanos , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/terapia , Mucormicose/complicações , Mucormicose/diagnóstico , Mucormicose/terapia , Micoses/diagnóstico , Micoses/terapia , Pandemias , Pneumonia Viral/diagnósticoRESUMO
BACKGROUND: Neonatal invasive candidiasis (IC) presenting in the first week of life is less common and less well described than later-onset IC. Risk factors, clinical features, and disease outcomes have not been studied in early-onset disease (EOD, ≤7 days) or compared to late-onset disease (LOD, >7 days). METHODS: All extremely low birth weight (ELBW, <1000 g) cases with IC and controls from a multicenter study of neonatal candidiasis enrolled from 2001 to 2003 were included in this study. Factors associated with occurrence and outcome of EOD in ELBW infants were determined. RESULTS: Forty-five ELBW infants and their 84 matched controls were included. Fourteen (31%) ELBW infants had EOD. Birth weight <750 g, gestation <25 weeks, chorioamnionitis, and vaginal delivery were all strongly associated with EOD. Infection with Candida albicans, disseminated disease, pneumonia, and cardiovascular disease were significantly more common in EOD than in LOD. The EOD case fatality rate (71%) was higher than in LOD (32%) or controls (15%) (P = .0001). The rate of neurodevelopmental impairment and mortality combined was similar in EOD (86%) and LOD (72%), but higher than in controls (32%; P = .007). CONCLUSIONS: ELBW infants with EOD have a very poor prognosis compared to those with LOD. The role of perinatal transmission in EOD is supported by its association with chorioamnionitis, vaginal delivery, and pneumonia. Dissemination and cardiovascular involvement are common, and affected infants often die. Empiric treatment should be considered for ELBW infants delivered vaginally who have pneumonia and whose mothers have chorioamnionitis or an intrauterine foreign body.
Assuntos
Candidíase Invasiva/epidemiologia , Candidíase Invasiva/etiologia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/etiologia , Idade de Início , Candidíase Invasiva/diagnóstico , Candidíase Invasiva/terapia , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/terapia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Fatores de RiscoRESUMO
The European Conference on Infections in Leukemia (ECIL) provides recommendations for diagnostic strategies and prophylactic, pre-emptive or targeted therapy strategies for various types of infection in patients with hematologic malignancies or hematopoietic stem cell transplantation recipients. Meetings are held every two years since 2005 and evidence-based recommendations are elaborated after evaluation of the literature and discussion among specialists of nearly all European countries. In this manuscript, the ECIL group presents the 2015-update of the recommendations for the targeted treatment of invasive candidiasis, aspergillosis and mucormycosis. Current data now allow a very strong recommendation in favor of echinocandins for first-line therapy of candidemia irrespective of the underlying predisposing factors. Anidulafungin has been given the same grading as the other echinocandins for hemato-oncological patients. The beneficial role of catheter removal in candidemia is strengthened. Aspergillus guidelines now recommend the use of either voriconazole or isavuconazole for first-line treatment of invasive aspergillosis, while first-line combination antifungal therapy is not routinely recommended. As only few new data were published since the last ECIL guidelines, no major changes were made to mucormycosis recommendations.
Assuntos
Aspergilose/etiologia , Aspergilose/terapia , Candidíase Invasiva/etiologia , Candidíase Invasiva/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Leucemia/complicações , Mucormicose/etiologia , Mucormicose/terapia , Antifúngicos/uso terapêutico , Aspergilose/diagnóstico , Candidíase Invasiva/diagnóstico , Ensaios Clínicos como Assunto , Terapia Combinada , Gerenciamento Clínico , Europa (Continente) , Humanos , Leucemia/terapia , Mucormicose/diagnóstico , Resultado do TratamentoRESUMO
Candida albicans is a yeast-like pathogen and can cause life-threatening systemic candidiasis. Its cell surface is enriched with mannan that is resistant to complement activation. Previously, we developed the recombinant human IgG1 antimannan antibody M1g1. M1g1 was found to promote complement activation and phagocytosis and protect mice from systemic candidiasis. Here, we evaluate the influence of IgG subclass on antimannan antibody-mediated protection. Three IgG subclass variants of M1g1 were constructed: M1g2, M1g3, and M1g4. The IgG subclass identity for each variant was confirmed with DNA sequence and subclass-specific antibodies. These variants contain identical M1 Fabs and exhibited similar binding affinities for C. albicans yeast and purified mannan. Yeast cells and hyphae recovered from the kidney of antibody-treated mice with systemic candidiasis showed uniform binding of each variant, indicating constitutive expression of the M1 epitope and antibody opsonization in the kidney. All variants promoted deposition of both murine and human C3 onto the yeast cell surface, with M1g4 showing delayed activation, as determined by flow cytometry and immunofluorescence microscopy. M1g4-mediated complement activation was found to be associated with its M1 Fab that activates the alternative pathway in an Fc-independent manner. Treatment with each subclass variant extended the survival of mice with systemic candidiasis (P < 0.001). However, treatment with M1g1, M1g3, or M1g4, but not with M1g2, also reduced the kidney fungal burden (P < 0.001). Thus, the role of human antimannan antibody in host resistance to systemic candidiasis is influenced by its IgG subclass.
Assuntos
Candida albicans/imunologia , Candidíase Invasiva/imunologia , Candidíase Invasiva/prevenção & controle , Imunoglobulina G/administração & dosagem , Imunoglobulina G/imunologia , Rim/microbiologia , Mananas/imunologia , Animais , Anticorpos Antifúngicos/administração & dosagem , Anticorpos Antifúngicos/imunologia , Anticorpos Antifúngicos/uso terapêutico , Sítios de Ligação de Anticorpos , Candida albicans/isolamento & purificação , Candida albicans/ultraestrutura , Candidíase Invasiva/terapia , Ativação do Complemento , Complemento C3/imunologia , Complemento C3/metabolismo , Feminino , Humanos , Imunização Passiva , Fragmentos Fab das Imunoglobulinas/genética , Fragmentos Fab das Imunoglobulinas/imunologia , Imunoglobulina G/classificação , Imunoglobulina G/uso terapêutico , Camundongos Endogâmicos BALB C , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/uso terapêuticoRESUMO
Candida spp. are commonly found in humans, colonizing most healthy individuals. A high prevalence of invasive candidiasis has been reported in recent years. Here, we assess the relation between Candida spp. as part of the human mycobiome, the host defense mechanisms, and the pathophysiology of invasive disease in critically ill patients. Many hypotheses have been proposed to explain the different immune responses to the process where Candida goes through healthy mycobiome to colonization to invasion; the involvement of other microbiota inhabitants, changes in temperature, low nitrogen levels, and the caspase system activation have been described. Patients admitted to an intensive care unit (ICU) are at the highest risk for invasive candidiasis, mostly due to the severity of their disease, immune-suppressive states, prolonged length of stay, broad-spectrum antibiotics, septic shock, and Candida colonization. The first approach should be using predictive scores as screening, followed by the determination of biomarkers (when available), and, in the near future, probably immune-genomics and analysis of the clinical background in order to initiate prompt and correct treatment. Regarding treatment, the initiation with an echinocandin is strongly recommended in critically ill patients. In conclusion, prompt treatment and adequate source control in the more severe patients remains the ultimate goal, as well as restoration of a healthy microbiota.
Assuntos
Candidíase Invasiva , Micobioma , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/microbiologia , Candidíase Invasiva/prevenção & controle , Candidíase Invasiva/terapia , Humanos , Fatores de RiscoRESUMO
We describe a case of fungal tenosynovitis with Candida parapsilosis, which is an uncommonly reported agent causing tenosynovitis. It occurred in an immunocompetent individual, and the patient underwent an extensive noninfectious work-up for ongoing swelling and stiffness before being correctly diagnosed and treated. We emphasize the importance of considering atypical infections in the differential diagnoses in a patient presenting with indolent symptoms of tenosynovitis.
Assuntos
Antifúngicos/uso terapêutico , Candida/isolamento & purificação , Candidíase Invasiva/microbiologia , Candidíase Invasiva/terapia , Equinocandinas/uso terapêutico , Traumatismos dos Dedos/microbiologia , Traumatismos dos Dedos/terapia , Lipopeptídeos/uso terapêutico , Tenossinovite/microbiologia , Tenossinovite/terapia , Voriconazol/uso terapêutico , Candida/classificação , Terapia Combinada , Humanos , Masculino , Micafungina , Pessoa de Meia-IdadeRESUMO
Echinocandins are indicated as first-line treatment for invasive candidiasis in moderate to severe illness. As sepsis is the main cause of acute kidney injury, the combination of echinocandin treatment and continuous renal replacement therapy (CRRT) is common. Optimizing antibiotic dosage in critically ill patients receiving CRRT is challenging. The pharmacokinetics of echinocandins have been studied under various clinical conditions; however, data for CRRT patients are scarce. Classically, drugs like echinocandins with high protein binding and predominantly non-renal elimination are not removed by CRRT, indicating that no dosage adjustment is required. However, recent studies report different proportions of echinocandins lost by filter adsorption. Nevertheless, the clinical significance of these findings remains unclear.
Assuntos
Antifúngicos/administração & dosagem , Estado Terminal/terapia , Equinocandinas/administração & dosagem , Terapia de Substituição Renal/métodos , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/terapia , Antifúngicos/farmacocinética , Candidíase Invasiva/diagnóstico , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/terapia , Terapia Combinada/métodos , Estado Terminal/epidemiologia , Equinocandinas/farmacocinética , Humanos , Resultado do TratamentoAssuntos
Antifúngicos/uso terapêutico , Candidíase Invasiva , Candida/isolamento & purificação , Candidíase Invasiva/diagnóstico , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/microbiologia , Candidíase Invasiva/terapia , Infecções Relacionadas a Cateter/terapia , Farmacorresistência Fúngica , HumanosRESUMO
INTRODUCTION: Patients with severe acute pancreatitis are at risk of candidal infections carrying the potential risk of an increase in mortality. Since early diagnosis is problematic, several clinical risk scores have been developed to identify patients at risk. Such patients may benefit from prophylactic antifungal therapy while those patients who have a low risk of infection may not benefit and may be harmed. The aim of this study was to assess the validity and discrimination of existing risk scores for invasive candidal infections in patients with severe acute pancreatitis. METHODS: Patients admitted with severe acute pancreatitis to the intensive care unit were analysed. Outcomes and risk factors of admissions with and without candidal infection were compared. Accuracy and discrimination of three existing risk scores for the development of invasive candidal infection (Candida score, Candida Colonisation Index Score and the Invasive Candidiasis Score) were assessed. RESULTS: A total of 101 patients were identified from 2003 to 2011 and 18 (17.8%) of these developed candidal infection. Thirty patients died, giving an overall hospital mortality of 29.7%. Hospital mortality was significantly higher in patients with candidal infection (55.6% compared to 24.1%, P=0.02). Candida colonisation was associated with subsequent candidal infection on multivariate analysis. The Candida Colonisation Index Score was the most accurate test, with specificity of 0.79 (95% confidence interval [CI] 0.68 to 0.88), sensitivity of 0.67 (95% CI 0.41 to 0.87), negative predictive value of 0.91 (95% CI 0.82 to 0.97) and a positive likelihood ratio of 3.2 (95% CI 1.9 to 5.5). The Candida Colonisation Index Score showed the best discrimination with area under the receiver operating characteristic curve of 0.79 (95% CI 0.69 to 0.87). CONCLUSIONS: In this study the Candida Colonisation Index Score was the most accurate and discriminative test at identifying which patients with severe acute pancreatitis are at risk of developing candidal infection. However its low sensitivity may limit its clinical usefulness.
Assuntos
Candidíase Invasiva/mortalidade , Estado Terminal/mortalidade , Pancreatite/mortalidade , Índice de Gravidade de Doença , Doença Aguda , Adulto , Idoso , Candidíase Invasiva/diagnóstico , Candidíase Invasiva/terapia , Estado Terminal/terapia , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico , Pancreatite/terapia , Valor Preditivo dos Testes , Estudos RetrospectivosRESUMO
Better prognostic predictors for invasive candidiasis (IC) are needed to tailor and individualize therapeutic decision-making and minimize its high morbidity and mortality. We investigated whether molecular profiling of IgG-antibody response to the whole soluble Candida proteome could reveal a prognostic signature that may serve to devise a clinical-outcome prediction model for IC and contribute to known IC prognostic factors. By serological proteome analysis and data-mining procedures, serum 31-IgG antibody-reactivity patterns were examined in 45 IC patients randomly split into training and test sets. Within the training cohort, unsupervised two-way hierarchical clustering and principal-component analyses segregated IC patients into two antibody-reactivity subgroups with distinct prognoses that were unbiased by traditional IC prognostic factors and other patients-related variables. Supervised discriminant analysis with leave-one-out cross-validation identified a five-IgG antibody-reactivity signature as the most simplified and accurate IC clinical-outcome predictor, from which an IC prognosis score (ICPS) was derived. Its robustness was confirmed in the test set. Multivariate logistic-regression and receiver-operating-characteristic curve analyses demonstrated that the ICPS was able to accurately discriminate IC patients at high risk for death from those at low risk and outperformed conventional IC prognostic factors. Further validation of the five-IgG antibody-reactivity signature on a multiplexed immunoassay supported the serological proteome analysis results. The five IgG antibodies incorporated in the ICPS made biologic sense and were associated either with good-prognosis and protective patterns (those to Met6p, Hsp90p, and Pgk1p, putative Candida virulence factors and antiapoptotic mediators) or with poor-prognosis and risk patterns (those to Ssb1p and Gap1p/Tdh3p, potential Candida proapoptotic mediators). We conclude that the ICPS, with additional refinement in future larger prospective cohorts, could be applicable to reliably predict patient clinical-outcome for individualized therapy of IC. Our data further provide insights into molecular mechanisms that may influence clinical outcome in IC and uncover potential targets for vaccine design and immunotherapy against IC.
Assuntos
Anticorpos Antifúngicos/sangue , Anticorpos Antifúngicos/imunologia , Candida/imunologia , Candidíase Invasiva/sangue , Candidíase Invasiva/imunologia , Mapeamento de Peptídeos/métodos , Adulto , Idoso , Candidíase Invasiva/terapia , Análise por Conglomerados , Estudos de Coortes , Feminino , Humanos , Imunoensaio , Imunoglobulina G/imunologia , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Prognóstico , Reprodutibilidade dos Testes , Solubilidade , Resultado do TratamentoRESUMO
The Practice Guidelines Committee of the American Society of Transplantation and Cellular Therapy (ASTCT) partnered with its Transplant Infectious Disease Special Interest Group (TID-SIG) to update its 2009 compendium-style infectious disease guidelines for hematopoietic cell transplantation (HCT). A completely new approach was taken with the goal of better serving clinical providers by publishing each standalone topic in the infectious disease series as a concise format of frequently asked questions (FAQ), tables, and figures. Adult and pediatric infectious disease and HCT content experts developed and then answered FAQs and finalized topics with harmonized recommendations made by assigning an A through E strength of recommendation paired with a level of supporting evidence graded I through III. This sixth guideline in the series focuses on invasive candidiasis (IC) with FAQs to address epidemiology, clinical diagnosis, prophylaxis, and treatment of IC, plus special considerations for pediatric, cord blood, haploidentical, and T cell-depleted HCT recipients and chimeric antigen receptor T cell recipients, as well as future research directions.
Assuntos
Candidíase Invasiva , Transplante de Células-Tronco Hematopoéticas , Adulto , Humanos , Criança , Estados Unidos/epidemiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/terapia , TransplantadosRESUMO
Invasive fungal infections are gaining increasing importance in intensive care medicine. The aim of this article is to present an update on recent developments in the field of invasive fungal infection in critically ill patients. Particular emphasis is placed on the recently described invasive mold infections in patients with acute respiratory distress syndrome due to influenza or COVID-19. Detecting high-risk patients and the optimal diagnostic and therapeutic strategies play a decisive role to improve outcome.
Assuntos
COVID-19/complicações , Influenza Humana/complicações , Infecções Fúngicas Invasivas/epidemiologia , Síndrome do Desconforto Respiratório/complicações , Biomarcadores , COVID-19/epidemiologia , Candidíase Invasiva/diagnóstico , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/terapia , Humanos , Incidência , Influenza Humana/epidemiologia , Unidades de Terapia Intensiva , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/terapia , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/epidemiologia , Aspergilose Pulmonar Invasiva/terapia , Síndrome do Desconforto Respiratório/etiologiaRESUMO
Candida is one of the most frequent pathogens in bloodstream infections, and is associated with significant morbidity and mortality. The epidemiology of species responsible for invasive candidiasis, both at local and worldwide levels, has been changing - shifting from Candida albicans to non-albicans species, which can be resistant to fluconazole (Candida krusei and Candida glabrata) or difficult to eradicate because of biofilm production (Candida parapsilosis). Numerous intensive care unit patients have multiple risk factors for developing this infection, which include prolonged hospitalisation, use of broad-spectrum antibiotics, presence of intravascular catheters, parenteral nutrition, high Acute Physiology and Chronic Health Evaluation score, and so forth. Moreover, delaying the specific therapy was shown to further increase morbidity and mortality. To minimise the impact of this infection, several management strategies have been developed - prophylaxis, empirical therapy, pre-emptive therapy and culture-based treatment. Compared with prophylaxis, empirical and pre-emptive approaches allow one to reduce the exposure to antifungals by targeting only the patients at high risk of candidemia, without delaying therapy until the moment blood Candida is identified in blood cultures. The agents recommended for initial treatment of candidemia in critically ill patients include echinocandins and lipid formulation of amphotericin B.
Assuntos
Candidíase Invasiva/terapia , Unidades de Terapia Intensiva , Sistemas Automatizados de Assistência Junto ao Leito , Candida/isolamento & purificação , Candidíase Invasiva/sangue , Candidíase Invasiva/diagnóstico , Gerenciamento Clínico , Humanos , Unidades de Terapia Intensiva/tendências , Sistemas Automatizados de Assistência Junto ao Leito/tendências , Fatores de RiscoRESUMO
BACKGROUND: Candidemia or invasive candidiasis (IC) is an increasingly common fungal infection and has been associated with high mortality, particularly among the immunocompromised and critically ill. Although several studies have been conducted to estimate the cost of managing candidemia and IC, quality assessment on the methodological aspects of these cost studies was not performed. To date, no systematic review focusing on the economic burden of candidemia and IC has ever been conducted. OBJECTIVES: The aim of this study was to systematically review the available evidence on the economic burden of candidemia and IC worldwide. METHODS: Databases (ie, PubMed, Scopus, EconLit, HEORO, and Ovid/Embase) were searched through June 2018. Two researchers independently assessed the quality of the eligible studies. Costs reported in the included studies were converted to 2016 USD using Campbell and Cochrane Economics Methods Group-the Evidence for Policy and Practice Information (CCEMG-EPPI)-Centre Cost Converter software. RESULTS: Eight articles were included in this systematic review. The mean total cost per patient with candidemia and IC ranged from $48 487 to $157 574, whereas the mean cost per hospitalization associated with candidemia and IC was from $10 216 to $37 715. All studies were from developed Western countries and reported only direct costs of candidemia and IC. Hospitalization was the main cost driver, contributing to more than half of the total costs. CONCLUSION: Quality cost studies on candidemia and IC based on standardized methods to provide informed decision making among healthcare authorities in implementing appropriate strategies is anticipated, in particular in developing countries.
Assuntos
Candidemia/economia , Candidíase Invasiva/economia , Efeitos Psicossociais da Doença , Candidemia/terapia , Candidíase Invasiva/terapia , Custos de Cuidados de Saúde/tendências , Hospitalização/economia , Humanos , Tempo de Internação/economiaRESUMO
BACKGROUND: Invasive fungal diseases (IFD) are a serious threat, but physicians in Asia lack access to many advanced diagnostics in mycology. It is likely that they face other impediments in the management of IFD. A gap analysis was performed to understand the challenges Asian physicians faced in medical mycology. METHODS: The Asia Fungal Working Group (AFWG) conducted a web-based survey on management practices for IFD among clinicians in China, India, Indonesia, Philippines, Singapore, Taiwan and Thailand. FINDINGS: Among 292 respondents, 51.7% were infectious disease (ID) specialists. Only 37% of respondents had received formal training in medical mycology. They handled only around 2-4 proven cases of each fungal infection monthly, with invasive candidiasis the most common. For laboratory support, the majority had access to direct microscopy (96%) and histopathology (87%), but galactomannan and azole levels were available to 60% and 25% of respondents, respectively. The majority (84%) used clinical parameters for treatment response monitoring, and 77% followed the Infectious Diseases Society of America guidelines. The majority (84%) did not use the services of an ID physician. Where febrile neutropenia was concerned, 74% of respondents used the empirical approach. Only 30% had an antifungal stewardship program in their hospital. Eighty percent could not use preferred antifungals because of cost. INTERPRETATION: The survey identified inadequacies in medical mycology training, non-culture diagnostics, access to antifungal drugs, and local guidelines as the major gaps in the management of IFDs in Asian countries. These gaps are targets for improvement.
Assuntos
Infecções Fúngicas Invasivas/terapia , Antifúngicos/uso terapêutico , Candidíase Invasiva/terapia , China , Competência Clínica , Educação Médica , Galactose/análogos & derivados , Humanos , Índia , Indonésia , Infecções Fúngicas Invasivas/tratamento farmacológico , Mananas/metabolismo , Micologia/educação , Filipinas , Singapura , Inquéritos e Questionários , Taiwan , TailândiaAssuntos
Albuminas/administração & dosagem , Antifúngicos/administração & dosagem , Antifúngicos/sangue , Candidíase Invasiva/sangue , Candidíase Invasiva/terapia , Estado Terminal/terapia , Equinocandinas/administração & dosagem , Equinocandinas/sangue , Diálise Renal , Terapia de Substituição Renal/métodos , HumanosAssuntos
Albuminas/administração & dosagem , Antifúngicos/sangue , Candidíase Invasiva/sangue , Candidíase Invasiva/terapia , Equinocandinas/sangue , Diálise Renal , Anidulafungina , Antifúngicos/uso terapêutico , Candidíase Invasiva/diagnóstico , Equinocandinas/uso terapêutico , Humanos , Diálise Renal/efeitos adversosRESUMO
INTRODUCTION: The term invasive candidiasis (IC) refers to both bloodstream and deep-seated invasive infections, such as peritonitis, caused by Candida species. Several guidelines on the management of candidemia and invasive infection due to Candida species have recently been published, but none of them focuses specifically on critically ill patients admitted to intensive care units (ICUs). MATERIAL AND METHODS: In the absence of available scientific evidence, the resulting recommendations are based solely on epidemiological and clinical evidence in conjunction with expert opinion. The task force used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to evaluate the recommendations and assign levels of evidence. The recommendations and their strength were decided by consensus and, if necessary, by vote (modified Delphi process). Descriptive statistics were used to analyze the results of the Delphi process. Statements obtaining > 80% agreement were considered to have achieved consensus. CONCLUSIONS: The heterogeneity of this patient population necessitated the creation of a mixed working group comprising experts in clinical microbiology, infectious diseases and intensive care medicine, all chosen on the basis of their expertise in the management of IC and/or research methodology. The working group's main goal was to provide clinicians with clear and practical recommendations to optimize microbiological diagnosis and treatment of IC. The Systemic Inflammation and Sepsis and Infection sections of the European Society of Intensive Care Medicine (ESICM) and the Critically Ill Patients Study Group of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) therefore decided to develop a set of recommendations for application in non-immunocompromised critically ill patients.
Assuntos
Antifúngicos/uso terapêutico , Candidíase Invasiva/terapia , Gerenciamento Clínico , Candidíase Invasiva/complicações , Estado Terminal/terapia , Técnica Delphi , Equinocandinas/uso terapêutico , Fluconazol/uso terapêutico , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Sepse/complicações , Sepse/terapiaRESUMO
There are major differences in the epidemiology and prognosis of invasive candidiasis and candidemia in the neutropenic patient; however, a recent study performed in Spanish hospitals (Candipop) confirmed that mortality at 1 month is 30%, which is similar to that observed in the general population. Although Candida albicans is the most frequently isolated species, C. tropicalis, C. glabrata, and C. krusei are more prevalent than in non-neutropenic patients. The benefit of neutrophil transfusion is unclear, and catheter withdrawal must be tailored and based on confirmation of the diagnosis. Echinocandins are the first-line option for therapy and have a better safety profile than other agents.
Assuntos
Antifúngicos/uso terapêutico , Candidíase Invasiva/complicações , Candidíase Invasiva/terapia , Neutropenia/complicações , Neutropenia/terapia , Transfusão de Sangue , Candidíase Invasiva/epidemiologia , Equinocandinas/uso terapêutico , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/terapia , Humanos , Neutropenia/epidemiologia , Neutrófilos , PrevalênciaRESUMO
Invasive candidiasis is a collective term that refers to a group of infectious syndromes caused by a variety of species of Candida, 5 of which cause most cases. Candidemia is the most commonly recognized syndrome associated with invasive candidiasis. Certain conditions may influence the likelihood for one species versus another in a specific clinical scenario, and this can have important implications for selection of antifungal therapy and the duration of treatment. Molecular diagnostic technology plays an ever-increasing role as an adjunct to traditional culture-based diagnostics, offering significant potential toward improvement in patient care.