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When and How to Cover for Fungal Infections in Patients with Severe Sepsis and Septic Shock

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Abstract

Candida species remain the most frequently isolated fungi in intensive care unit (ICU) patients with severe sepsis or septic shock. Delayed antifungal therapy in these patients is a recognized risk factor for mortality. However, the diagnosis of invasive candidiasis remains difficult and is frequently delayed. Clinical scores have been proposed to assess the risk of development of invasive candidiasis or candidemia. Laboratory tools for early diagnosis are disappointing or still under development. Triazoles, polyenes, and echinocandins are the key drugs used to treat invasive candidiasis in ICU patients with similar efficacy, but very variable tolerability. The increasing incidence of fluconazole-resistant and susceptible-dose dependent strains and the safety profile of antifungal agents must be taken into account when selecting empiric therapy, frequently leading to the initial use of echinocandins in ICU patients with severe sepsis or septic shock.

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Disclosure

Philippe Montravers has recieved payment for consultancy, development of educational presentations, and travel and accomodation reimbursement from from Astellas, Merck, and Pfizer; Nicolas Allou and Jerome Allyn reported no potential conflicts of interest relevant to this article.

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  1. Department of Anesthesiology and Surgical Intensive Care Unit, CHU Bichat-Claude Bernard, Assistance Publique Hôpitaux de Paris; Université Paris VII Denis Diderot, 46 rue Henri Huchard, 75018, Paris, France

    Nicolas Allou, Jerome Allyn & Philippe Montravers

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  1. Nicolas Allou
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Correspondence to Philippe Montravers.

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Allou, N., Allyn, J. & Montravers, P. When and How to Cover for Fungal Infections in Patients with Severe Sepsis and Septic Shock. Curr Infect Dis Rep 13, 426–432 (2011). https://doi.org/10.1007/s11908-011-0204-x

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