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Article dans une revue

Antifungal treatment (except haematology). What do the data really show?

Abstract : Yeast infections are becoming more common in intensive care. Moreover, they are clearly associated with an increase in morbidity and mortality. Candida albicans is the most common species in invasive candidiasis in ICU and in Europe. Many risk factors are identified and a number of predictive scores for candidiasis have been developed but they are not performing well. The delayed start of treatment is an independent factor of mortality. Four classes of antifungals are available: polyenes, triazoles, echinocandins and flucytosine. Their cellular action mechanisms and activity spectra are different and must be known. In patients with severe candidemia, firstline therapy should include an echinocandin for 14 days after the first negative blood culture. An extension assessment should always be performed in case of candidemia (occular examination and trans-oesophageal echocardiography). During intra-abdominal infections, antifungal treatment with echinocandin should probably be introduced if at least 3 predictive criteria are present (haemodynamic failure, female gender, sus-mesocolic surgery, antibiotic therapy for more than 48 hours) or in case of direct positive examination to yeast. All recommendations on preventive antifungal therapy are recommendations of very low level of evidence and do not allow to define a therapeutic strategy. Therapeutic de-escalation should be as early as possible and seem to have no impact on morbidity and mortality.
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Soumis le : mercredi 16 février 2022 - 16:04:37
Dernière modification le : jeudi 25 août 2022 - 10:52:24



Pierre Huette, Hervé Dupont. Antifungal treatment (except haematology). What do the data really show?. Anesthésie & Réanimation, Elsevier Masson, 2019, 5 (4), pp.300-309. ⟨10.1016/j.anrea.2019.03.004⟩. ⟨hal-03577298⟩



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