Current opinion in critical care · 2008
Is Candida really a threat in the ICU?
СтатьяПоддержка исследования: вне правительства СШАОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Blot Stijn, Dimopoulos George, Rello Jordi, Vogelaers Dirk
Аннотация
PURPOSE OF REVIEW: The epidemiological and clinical relevance of Candida in the ICU is reviewed. Three issues were appraised. First is the prevalence of Candida. Second is the relevance of nonblood cultures positive for Candida and multisite colonization. Third is the importance of invasive candidiasis in terms of mortality.
RECENT FINDINGS: The diagnosis of invasive candidiasis remains problematic in nonblood cultures. Consequently, the true prevalence of invasive candidiasis is difficult to assess. Another result of the complicated diagnosis is the risk for delayed antifungal therapy in case of systemic Candida infection. Therefore, pre-emptive therapy has become increasingly popular in high-risk patients.
SUMMARY: Candida spp. cause a minority of nosocomial bloodstream infections ( approximately 4-9%). Yet, delayed initiation of appropriate antifungal therapy results in significant attributable mortality. Given the inability to efficiently discriminate colonization from invasive candidiasis, this is a problematic issue. The presence of Candida in tracheal aspirates, urine cultures or wound swabs frequently reflects colonization. Yet, multisite colonization frequently precedes systemic invasion. As such, multisite Candida colonization is a crucial element in the decision to start pre-emptive therapy. However, the predictive value of multisite colonization in the absence of an overt risk profile for invasive candidiasis appears to be low.
RECENT FINDINGS: The diagnosis of invasive candidiasis remains problematic in nonblood cultures. Consequently, the true prevalence of invasive candidiasis is difficult to assess. Another result of the complicated diagnosis is the risk for delayed antifungal therapy in case of systemic Candida infection. Therefore, pre-emptive therapy has become increasingly popular in high-risk patients.
SUMMARY: Candida spp. cause a minority of nosocomial bloodstream infections ( approximately 4-9%). Yet, delayed initiation of appropriate antifungal therapy results in significant attributable mortality. Given the inability to efficiently discriminate colonization from invasive candidiasis, this is a problematic issue. The presence of Candida in tracheal aspirates, urine cultures or wound swabs frequently reflects colonization. Yet, multisite colonization frequently precedes systemic invasion. As such, multisite Candida colonization is a crucial element in the decision to start pre-emptive therapy. However, the predictive value of multisite colonization in the absence of an overt risk profile for invasive candidiasis appears to be low.