6533b82bfe1ef96bd128cf07

RESEARCH PRODUCT

Untargeted Antifungal Treatment Strategies for Invasive Candidiasis in Non-neutropenic Critically Ill Patients: Current Evidence and Insights

Cesare GregorettiVincenzo RussottoAndrea CortegianiSanti Maurizio RaineriAntonino GiarratanoFrancesco G. De Rosa

subject

Antifungalmedicine.medical_specialtyEmpiric treatmentmedicine.drug_classInvasive candidiasiBiology03 medical and health sciences0302 clinical medicineInvasive fungal infectionmedicine030212 general & internal medicineAntifungal treatmentMED/41 - ANESTESIOLOGIAIntensive care medicineCandida infectionCritically illCandidemia030208 emergency & critical care medicineInvasive candidiasismedicine.diseaseNon neutropenicClinical PracticeInvasive candidiasisInfectious DiseasesSystematic reviewTreatment strategyAntifungal treatment; Candida infection; Candidemia; Empiric treatment; Invasive candidiasis; Invasive fungal infectionEmpiric treatment

description

Purpose of Review: The purpose of this study was to provide an overview and insights on important new concepts on untargeted antifungal treatment strategies, namely prophylaxis pre-emptive and empiric treatments for the management of invasive candidiasis (IC) in non-neutropenic critically ill patients. Recent Findings: Recently, clinical practice guidelines provided recommendation for the management of IC. However, results from recent trials and systematic reviews questioned the effect of untargeted antifungal treatment strategies, especially in terms of survival benefits in non-neutropenic patients, even with septic shock. Summary: Widespread use of untargeted antifungal treatment strategies seems not to be justified anymore. Future research should evaluate comprehensive diagnostic-therapeutic approaches, including the implementation of de-escalation. In the meanwhile, clinicians should take into account all available sources of information including clinical evaluation, risk factor assessment, scores, and surrogate biomarkers to tailor antifungal treatment before definitive microbiological diagnosis.

yearjournalcountryeditionlanguage
2017-07-22
10.1007/s12281-017-0288-3http://hdl.handle.net/2318/1869110