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Therapeutic variability in the treatment of Candida colonization/infection in non-neutropenic critically ill patients

Background

To determine the therapeutic variability in the treatment of Candida colonization or invasive candidiasis (IC) among critically ill patients (pts).

Methods

Prospective observational multicenter study from May 1998–January 1999 in pts staying ≥ 7 days in 73 Spanish intensive care units (ICU). Surveillance cultures were performed weekly from: tracheal aspirates, urine, and gut (oropharynx ± gastric aspirates). The pts were catalogued in two groups: colonized (appearance or persistence of Candida in surveillance cultures) and IC (defined as any one or more of the following: candidemia, endophtalmitis, other infections [OI]: peritonitis, organ biopsy). Multisite colonization (MC) was defined as ≥ 2 sites positive from surveillance cultures, and persistent MC as positive cultures in ≥ 1 week.

Results

We analyzed 1765 consecutive pts: 961 were considered colonized or infected by Candida species, of them, 55 presented candidemia, 35 OI, 7 endophtalmitis, and 864 pts were considered colonized. Were treated with antifungal drugs 48/55 (87.2%), 27/35 (77.1%) and 267/864 (20.9%) of the pts with candidemia, OI and colonized groups, respectively. All pts with endophtalmitis were treated. 57 pts received a second antifungal drug. Fluconazole was the antifungal drugs most used, as the first intention, especially in the colonized groups (86.4%) and less (57.1%) in the endophtalmitis group. The liposomal amphotericin B 18/58 (31.0%) was the most used as the alternative therapeutic. The time of treatment in the ICU was of the 7.7, 10.6, and 5.5.days in the candidemia, OI and endophtalmitis, respectively.

Conclusion

The kind and time of the antifungal treatment was different between the groups analized.

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León, C., Nolla, J., Jordá, R. et al. Therapeutic variability in the treatment of Candida colonization/infection in non-neutropenic critically ill patients. Crit Care 5, P100 (2001). https://doi.org/10.1186/cc1167

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Keywords

  • Intensive Care Unit
  • Peritonitis
  • Amphotericin
  • Fluconazole
  • Candidiasis