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[Antifungal treatments of candidemia in non-neutropenic patients: evaluation of practice in intensive care units].

Abstract：

OBJECTIVE:The authors had for objective to assess systemic antifungal treatment for candidemia in non-neutropenic patients, in intensive care units (ICU), and compare the results with French 2004 recommendations. STUDY DESIGN:A retrospective multicenter study (nine ICU in two teaching hospitals) was made. PATIENTS AND METHOD:Thirty-eight non-neutropenic patients with at least one positive blood culture for Candida who had received systemic antifungal treatment were included between May 2004 and September 2007. RESULTS:Thirty-nine cases of candidemia were analyzed. The median age was 54.5 (21-80), the median SAPS II score at admission was 44 (20-79), the median duration of stay in ICU was 22.5 days (2-82), and the death rate was 45%. Candida albicans was identified in 69% of the cases. Eight percent of Candida sp. isolates were resistant or susceptible dose-dependent (S-DD) to fluconazole. Before identification, fluconazole, caspofungin, voriconazole, and amphotericin B were used in 74%, 15%, 5%, and 5% of cases respectively. After identification and antifungal susceptibility determination, fluconazole was used in 68% of cases, caspofungin in 24% of cases, any formulation of amphotericin B in 6% of cases, voriconazole in 3% of cases. The French recommendations were applied in 71% of cases before identification and in 68% of cases after identification and antifungal susceptibility determination. CONCLUSION:The main causes of non-compliance to recommendations were the use of fluconazole in patients previously exposed to azole agents, the use of caspofungin in hemodynamically unstable patients, and the absence of therapeutic desescalade.

journal_name

Med Mal Infect

journal_title

Medecine et maladies infectieuses

authors

Massanet P,Corne P,Conseil M,Perrigault PF,Lachaud L,Jaber S,Calvet B,Jonquet O,Reynes J

doi

10.1016/j.medmal.2010.06.007

subject

Has Abstract

pub_date

2010-11-01 00:00:00

pages

644-9

issue

11

eissn

0399-077X

issn

1769-6690

pii

S0399-077X(10)00156-3

journal_volume

40

pub_type

杂志文章,多中心研究

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