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Fungal Sepsis in the Critically Ill
- In recent years, the incidence of invasive fungal infections has risen dramatically.
- Candida species (C. albicans, C. glabrata, C. parapsilosis, C tropicalis, C. krusei) account for the majority of invasive infections in the critically ill patient.
- Key risk factors for invasive candidal infections include:
- Exposure to broad spectrum antibiotics
- Cancer chemotherapy
- Indwelling catheters
- TPN administration
- Neutropenia
- Hemodialysis
- Given the significant mortality of invasive fungal infections, early and appropriate antifungal therapy is paramount.
- First-line empiric antifungal therapy recommendations from the Infectious Disease Society of America include caspofungin, micafungin, or fluconazole. Amphotericin B is now reserved for patients who are either intolerant or not responding to the echinocandins (caspofungin, micafungin).
References
Lepak A, Andes D. Fungal sepsis: Optimizing antifungal therapy in the critical care setting. Crit Care Clin 2011; 27:123-147.