Surgical Perspective on Invasive Candida Infections |
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Authors: | David A Dean Kenneth W Burchard |
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Institution: | (1) Section of General Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon New Hampshire 03756-0001, USA, US |
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Abstract: | Candida
infections have become a major source of morbidity and mortality in the modern surgical intensive care unit. The most common
risks for invasion and dissemination are the use of antibiotics, central venous lines, total parenteral nutrition, burns,
immunosuppression, and other markers for severity of illness (APACHE > 10, ventilatory use for > 48 hours). Data suggest that
colonization can be a late predictor of invasive disease in today’s critically ill surgical patient and that prophylaxis or
early treatment in high risk patients is warranted, particularly before invasive/disseminated disease becomes life-threatening.
When advanced disease is present, the diagnosis of invasive or disseminated
Candida
infection is often prompted by clinical suspicion and supported by consistent clinical data; laboratory tests alone lack
sufficient sensitivity and specificity to direct therapeutic decision-making. Once the diagnosis of invasive or disseminated
Candida
infection is ascertained, early systemic treatment, along with treatment of localized infection, is as fundamental as with
any other serious infectious disease. Reported toxicity and efficacy supports the use of fluconazole for most patients with
invasive/disseminated
Candida
infections. For the most critically ill surgical patient amphotericin B remains the treatment of choice. Prophylaxis and
early treatment strategies with minimally toxic agents may diminish the need to use more toxic therapy in the most severely
ill patients. |
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Keywords: | |
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