Περίληψη:
This part of the EFISG guidelines focuses on non-neutropenic adult patients. Only a few of the numerous recommendations can be summarized in the abstract. Prophylactic usage of fluconazole is supported in patients with recent abdominal surgery and recurrent gastrointestinal perforations or anastomotic leakages. Candida isolation from respiratory secretions alone should never prompt treatment. For the targeted initial treatment of candidaemia, echinocandins are strongly recommended while liposomal amphotericin B and voriconazole are supported with moderate, and fluconazole with marginal strength. Treatment duration for candidaemia should be a minimum of 14days after the end of candidaemia, which can be determined by one blood culture per day until negativity. Switching to oral treatment after 10days of intravenous therapy has been safe in stable patients with susceptible Candida species. In candidaemia, removal of indwelling catheters is strongly recommended. If catheters cannot be removed, lipid-based amphotericin B or echinocandins should be preferred over azoles. Transoesophageal echocardiography and fundoscopy should be performed to detect organ involvement. Native valve endocarditis requires surgery within a week, while in prosthetic valve endocarditis, earlier surgery may be beneficial. The antifungal regimen of choice is liposomal amphotericin B+/-flucytosine. In ocular candidiasis, liposomal amphotericin B+/-flucytosine is recommended when the susceptibility of the isolate is unknown, and in susceptible isolates, fluconazole and voriconazole are alternatives. Amphotericin B deoxycholate is not recommended for any indication due to severe side effects. © 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.
Συγγραφείς:
Cornely, O.A.
Bassetti, M.
Calandra, T.
Garbino, J.
Kullberg, B.J.
Lortholary, O.
Meersseman, W.
Akova, M.
Arendrup, M.C.
Arikan-Akdagli, S.
Bille, J.
Castagnola, E.
Cuenca-Estrella, M.
Donnelly, J.P.
Groll, A.H.
Herbrecht, R.
Hope, W.W.
Jensen, H.E.
Lass-Flörl, C.
Petrikkos, G.
Richardson, M.D.
Roilides, E.
Verweij, P.E.
Viscoli, C.
Ullmann, A.J.
Λέξεις-κλειδιά:
amphotericin B; amphotericin B deoxycholate; amphotericin B lipid complex; anidulafungin; caspofungin; echinocandin; efungumab; fluconazole; flucytosine; itraconazole; ketoconazole; micafungin; neomycin; nystatin; placebo; polymyxin B; posaconazole; rifampicin; vancomycin; voriconazole; antifungal agent, abdominal infection; abdominal surgery; anastomosis leakage; antibiotic prophylaxis; antibiotic sensitivity; antifungal activity; article; artificial heart pacemaker; aspergillosis; blood culture; bloodstream infection; Candida albicans; Candida endocarditis; Candida glabrata; Candida krusei; Candida meningitis; Candida parapsilosis; candidemia; candidiasis; candiduria; catheter infection; catheter removal; central venous catheter; chill; combination chemotherapy; critically ill patient; cystitis; digestive system perforation; disease duration; drug brain level; drug dose comparison; drug dose increase; drug formulation; drug megadose; drug penetration; drug safety; drug tolerability; endocarditis; endophthalmitis; eye infection; fever; fungemia; fungus isolation; heart valve prosthesis; heart valve surgery; human; implantable cardioverter defibrillator; indwelling catheter; intervertebral disk degeneration; invasive candidiasis; low drug dose; monotherapy; nephrotoxicity; nonhuman; ocular candidiasis; ophthalmoscopy; osteomyelitis; practice guideline; priority journal; prosthetic valve endocarditis; pyelonephritis; recurrent disease; transesophageal echocardiography; treatment duration; treatment response; unspecified side effect; urinary tract infection; ventricular assist device; adult; Candida; candidiasis; drug effect; evidence based medicine; isolation and purification, Adult; Antifungal Agents; Candida; Candidiasis; Evidence-Based Medicine; Humans
