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Current Infectious Disease Reports
Published in: Current Infectious Disease Reports 5/2011

01-10-2011

When and How to Cover for Fungal Infections in Patients with Severe Sepsis and Septic Shock

Authors: Nicolas Allou, Jerome Allyn, Philippe Montravers

Published in: Current Infectious Disease Reports | Issue 5/2011

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Abstract

Candida species remain the most frequently isolated fungi in intensive care unit (ICU) patients with severe sepsis or septic shock. Delayed antifungal therapy in these patients is a recognized risk factor for mortality. However, the diagnosis of invasive candidiasis remains difficult and is frequently delayed. Clinical scores have been proposed to assess the risk of development of invasive candidiasis or candidemia. Laboratory tools for early diagnosis are disappointing or still under development. Triazoles, polyenes, and echinocandins are the key drugs used to treat invasive candidiasis in ICU patients with similar efficacy, but very variable tolerability. The increasing incidence of fluconazole-resistant and susceptible-dose dependent strains and the safety profile of antifungal agents must be taken into account when selecting empiric therapy, frequently leading to the initial use of echinocandins in ICU patients with severe sepsis or septic shock.
Literature
1.
Zilberberg MD, Shorr AF, Kollef MH. Secular trends in candidemia-related hospitalization in the United States, 2000–2005. Infect Control Hosp Epidemiol. 2008;29:978–80.PubMedCrossRef
2.
• Vincent JL, Rello J, Marshall J, et al..: International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009; 302:2323–9. A large epidemiologic description of infection issues in ICU patients. PubMedCrossRef
3.
Wisplinghoff H, Bischoff T, Tallent SM, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39:309–17.PubMedCrossRef
4.
Harbarth S, Garbino J, Pugin J, et al. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med. 2003;115:529–35.PubMedCrossRef
5.
• Hsu DI, Nguyen M, Nguyen L, et al..: A multicentre study to evaluate the impact of timing of caspofungin administration on outcomes of invasive candidiasis in non-immunocompromised adult patients. J Antimicrob Chemother 2010; 65:1765–70. The authors provide additional proof of the importance of early antifungal therapy PubMedCrossRef
6.
Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother. 2005;49:3640–5.PubMedCrossRef
7.
Zilberberg MD, Kollef MH, Arnold H, et al. Inappropriate empiric antifungal therapy for candidemia in the ICU and hospital resource utilization: a retrospective cohort study. BMC Infect Dis. 2010;10:150.PubMedCrossRef
8.
Martin GS, Mannino DM, Eaton S, et al. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546–54.PubMedCrossRef
9.
Dombrovskiy VY, Martin AA, Sunderram J, et al. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med. 2007;35:1244–50.PubMedCrossRef
10.
Ellis M, Hedstrom U, Jumaa P, et al. Epidemiology, presentation, management and outcome of candidemia in a tertiary care teaching hospital in the United Arab Emirates, 1995–2001. Med Mycol. 2003;41:521–8.PubMedCrossRef
11.
Patel GP, Simon D, Scheetz M, et al. The effect of time to antifungal therapy on mortality in Candidemia associated septic shock. Am J Ther. 2009;16:508–11.PubMedCrossRef
12.
Viscoli C, Girmenia C, Marinus A, et al. Candidemia in cancer patients: a prospective, multicenter surveillance study by the Invasive Fungal Infection Group (IFIG) of the European Organization for Research and Treatment of Cancer (EORTC). Clin Infect Dis. 1999;28:1071–9.PubMedCrossRef
13.
Hadley S, Lee WW, Ruthazer R, et al. Candidemia as a cause of septic shock and multiple organ failure in nonimmunocompromised patients. Crit Care Med. 2002;30:1808–14.PubMedCrossRef
14.
Chow JK, Golan Y, Ruthazer R, et al. Risk factors for albicans and non-albicans candidemia in the intensive care unit. Crit Care Med. 2008;36:1993–8.PubMedCrossRef
15.
• Leroy O, Gangneux JP, Montravers P, et al..: Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005–2006). Crit Care Med 2009; 37:1612–1618. This is one of the first large-scale, prospective epidemiologic studies specifically focusing on ICU characteristics of patients with severe Candida infection. PubMedCrossRef
16.
Horvath LL, George BJ, Murray CK, et al. Direct comparison of the BACTEC 9240 and BacT/ALERT 3D automated blood culture systems for candida growth detection. J Clin Microbiol. 2004;42:115–8.PubMedCrossRef
17.
Montagna MT, Caggiano G, Borghi E, et al. The role of the laboratory in the diagnosis of invasive candidiasis. Drugs. 2009;69 Suppl 1:59–63.PubMedCrossRef
18.
Reboli AC, Rotstein C, Pappas PG, et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med. 2007;356:2472–82.PubMedCrossRef
19.
•• Pappas PG, Kauffman CA, Andes D, et al..: Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:503–535. The IDSA guidelines define the recommended management of severe Candida infections PubMedCrossRef
20.
Pittet D, Monod M, Suter PM, et al. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg. 1994;220:751–8.PubMedCrossRef
21.
Leon C, Ruiz-Santana S, Saavedra P, et al. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med. 2006;34:730–7.PubMedCrossRef
22.
Leon C, Ruiz-Santana S, Saavedra P, et al. Usefulness of the “Candida score” for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study. Crit Care Med. 2009;37:1624–33.PubMedCrossRef
23.
Ostrosky-Zeichner L, Sable C, Sobel J, et al. Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting. Eur J Clin Microbiol Infect Dis. 2007;26:271–6.PubMedCrossRef
24.
• Ostrosky-Zeichner L, Pappas PG, Shoham S, et al..: Improvement of a clinical prediction rule for clinical trials on prophylaxis for invasive candidiasis in the intensive care unit. Mycoses 2011; 54:46–51. An interesting approach to improve the relevance of a score for detection of severe Candida infections. PubMedCrossRef
25.
Khot PD, Fredricks DN. PCR-based diagnosis of human fungal infections. Expert Rev Anti Infect Ther. 2009;7:1201–21.PubMedCrossRef
26.
Bille J. New nonculture-based methods for the diagnosis of invasive candidiasis. Curr Opin Crit Care. 2010;16:460–4.PubMedCrossRef
27.
•• Guery BP, Arendrup MC, Auzinger G, et al..: Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part I. Epidemiology and diagnosis. Intensive Care Med 2009; 35:55–62. The authors provide an excellent review of this topic from a clinical perspective. PubMedCrossRef
28.
Yeo SF, Huie S, Sofair AN, et al. Measurement of serum D-arabinitol/creatinine ratios for initial diagnosis and for predicting outcome in an unselected, population-based sample of patients with Candida fungemia. J Clin Microbiol. 2006;44:3894–9.PubMedCrossRef
29.
Montravers P, Gauzit R, Muller C, et al. Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy. Clin Infect Dis. 1996;23:486–94.PubMedCrossRef
30.
Montravers P, Dupont H, Gauzit R, et al. Candida as a risk factor for mortality in peritonitis. Crit Care Med. 2006;34:646–52.PubMedCrossRef
31.
Dupont H, Paugam-Burtz C, Muller-Serieys C, et al. Predictive factors of mortality due to polymicrobial peritonitis with Candida isolation in peritoneal fluid in critically ill patients. Arch Surg. 2002;137:1341–6. discussion 1347.PubMedCrossRef
32.
Montravers P, Chalfine A, Gauzit R, et al. Clinical and therapeutic features of nonpostoperative nosocomial intra-abdominal infections. Ann Surg. 2004;239:409–16.PubMedCrossRef
33.
Riche FC, Dray X, Laisne MJ, et al. Factors associated with septic shock and mortality in generalized peritonitis: comparison between community-acquired and postoperative peritonitis. Crit Care. 2009;13:R99.PubMedCrossRef
34.
Dupont H, Bourichon A, Paugam-Burtz C, et al. Can yeast isolation in peritoneal fluid be predicted in intensive care unit patients with peritonitis? Crit Care Med. 2003;31:752–7.PubMedCrossRef
35.
Sandven P, Qvist H, Skovlund E, et al. Significance of Candida recovered from intraoperative specimens in patients with intra-abdominal perforations. Crit Care Med. 2002;30:541–7.PubMedCrossRef
36.
Mora-Duarte J, Betts R, Rotstein C, et al. Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med. 2002;347:2020–9.PubMedCrossRef
37.
Rex JH, Pappas PG, Karchmer AW, et al. A randomized and blinded multicenter trial of high-dose fluconazole plus placebo versus fluconazole plus amphotericin B as therapy for candidemia and its consequences in nonneutropenic subjects. Clin Infect Dis. 2003;36:1221–8.PubMedCrossRef
38.
Kullberg BJ, Sobel JD, Ruhnke M, et al. Voriconazole versus a regimen of amphotericin B followed by fluconazole for candidaemia in non-neutropenic patients: a randomised non-inferiority trial. Lancet. 2005;366:1435–42.PubMedCrossRef
39.
Kuse ER, Chetchotisakd P, da Cunha CA, et al. Micafungin versus liposomal amphotericin B for candidaemia and invasive candidosis: a phase III randomised double-blind trial. Lancet. 2007;369:1519–27.PubMedCrossRef
40.
• Dupont BF, Lortholary O, Ostrosky-Zeichner L, et al..: Treatment of candidemia and invasive candidiasis in the intensive care unit: post hoc analysis of a randomized, controlled trial comparing micafungin and liposomal amphotericin B. Crit Care 2009; 13:R159. An interesting comparison of ICU and non-ICU patients which suggests that analysis of clinical trials in ICU and in other types of patients is difficult to interpret. PubMedCrossRef
41.
von Mach MA, Burhenne J, Weilemann LS. Accumulation of the solvent vehicle sulphobutylether beta cyclodextrin sodium in critically ill patients treated with intravenous voriconazole under renal replacement therapy. BMC Clin Pharmacol. 2006;18:6:6.
42.
• Montravers P, Mira JP, Gangneux JP, et al..: A multicentre study of antifungal strategies and outcome of Candida spp. peritonitis in intensive-care units. Clin Microbiol Infect. 2011;17:1061–7. The first prospective description of a large cohort of patients with Candida peritonitis with relevant data on the therapeutic management of these cases.
43.
44.
Nguyen TH, Hoppe-Tichy T, Geiss HK, et al. Factors influencing caspofungin plasma concentrations in patients of a surgical intensive care unit. J Antimicrob Chemother. 2007;60:100–6.PubMedCrossRef
45.
Spriet I, Annaert P, Meersseman P, et al. Pharmacokinetics of caspofungin and voriconazole in critically ill patients during extracorporeal membrane oxygenation. J Antimicrob Chemother. 2009;63:767–70.PubMedCrossRef
46.
Rex JH, Bennett JE, Sugar AM, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. Candidemia Study Group and the National Institute. N Engl J Med. 1994;331:1325–30.PubMedCrossRef
47.
Pappas PG, Rotstein CM, Betts RF, et al. Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis. Clin Infect Dis. 2007;45:883–93.PubMedCrossRef
48.
• Betts RF, Nucci M, Talwar D, et al..: A Multicenter, double-blind trial of a high-dose caspofungin treatment regimen versus a standard caspofungin treatment regimen for adult patients with invasive candidiasis. Clin Infect Dis 2009; 48:1676–1684. An interesting approach which demonstrates that dosage is not a major issue with caspofungin. PubMedCrossRef
49.
Lewis RE. Decision making in antifungal monotherapy versus combination therapy. Pharmacotherapy. 2006;26:61S–7S.PubMedCrossRef
50.
Falcone M, Barzaghi N, Carosi G, et al. Candida infective endocarditis: report of 15 cases from a prospective multicenter study. Medicine (Baltimore). 2009;88:160–8.CrossRef
Metadata
Title
When and How to Cover for Fungal Infections in Patients with Severe Sepsis and Septic Shock
Authors
Nicolas Allou
Jerome Allyn
Philippe Montravers
Publication date
01-10-2011
Publisher
Current Science Inc.
Published in
Current Infectious Disease Reports / Issue 5/2011
Print ISSN: 1523-3847
Electronic ISSN: 1534-3146
DOI
https://doi.org/10.1007/s11908-011-0204-x

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