The Prevention of Invasive Candida Infection in Critically Ill Surgical Patients

  • S. L. Sylvester
  • P. Lipsett

Abstract

Over the past three decades, the significant morbidity and mortality associated with candidemia and invasive candidiasis have been well established. Technological and scientific advancement has led to an increase in the incidence of serious Candida infections. With the introduction of the azoles and more recently with the development of the echinocandin class of antifungals, our ability to treat these infections has improved; however, our ability to diagnose these infections in a timely fashion remains limited, and patient outcomes remain poor. Antifungal prophylaxis has emerged as a method to attempt to decrease the occurrence of these serious infections in selected high-risk patient populations. The role of antifungal prophylaxis is well established in bone marrow transplant recipients [1, 2]. In this chapter, we will review the role of antifungal prophylaxis in the surgical patient, with particular attention to the prevention of candidemia and invasive candidiasis in surgical intensive care unit (ICU) patients and abdominal organ transplant recipients.

Keywords

Transplant Recipient Candida Species Invasive Fungal Infection Invasive Candidiasis Liver Transplant Recipient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Goodman JL, Winston DJ, Greenfield RA, et al (1992) A controlled trial of fluconazole to prevent fungal infections after bone marrow transplantation. N Engl J Med 326: 845–851PubMedCrossRefGoogle Scholar
  2. 2.
    Slavin MA, Osborne B, Adams R, et al (1995) Efficacy and safety of fluconazole prophylaxis for fungal infections after bone marrow transplantation: a prospective, randomized, double-blind study. J Infect Dis 171: 1545–1552PubMedCrossRefGoogle Scholar
  3. 3.
    Fraser VJ, Jones M, Dunkel J, Storfer S, Medoff G, Dunagan WC (1992) Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality. Clin Infect Dis 15: 414–421PubMedCrossRefGoogle Scholar
  4. 4.
    Beck-Sague CM, Jarvis W, and the National Nosocomial Infections Surveillance System (1993) Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980–1990. J Infect Dis 167: 1247–1251PubMedCrossRefGoogle Scholar
  5. 5.
    Fridkin SK, Gaynes RP (1999) Antimicrobial resistance in intensive care units. Clin Chest Med 20: 303–316PubMedCrossRefGoogle Scholar
  6. 6.
    Blumberg HM, Jarvis WR, Soucie JM, et al (2001) Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study. Clin Infect Dis 33: 177–186PubMedCrossRefGoogle Scholar
  7. 7.
    Nieto-Rodriguez JA, Kusne S, Manez R, et al (1996) Factors associated with the development of candidemia and candidemia-related death among liver transplant recipients. Ann Surg 223: 70–76PubMedCrossRefGoogle Scholar
  8. 8.
    Lumbreras C, Cuervas-Mons V, Jara P (1996) Randomized trial of fluconazole versus nystatin for the prophylaxis of Candida infection following liver transplantation. J Infect Dis 174: 583–588PubMedCrossRefGoogle Scholar
  9. 9.
    Hadley S, Samore MH, Lewis WD, Jenkins RL, Karchmer AW, Hammer SM (1995) Major infectious complications after orthotopic liver transplantation and comparison of outcomes in patients receiving cyclosporine or FK506 as primary immunosuppression. Transplantation 59: 851–859PubMedGoogle Scholar
  10. 10.
    Winston DJ, Pakrasi A, Busuttil RW (1999) Prophylactic fluconazole in liver transplant recipients: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 131: 729–737PubMedCrossRefGoogle Scholar
  11. 11.
    Benedetti E, Gruessner AC, Troppmann C, et al (1996) Intra-abdominal fungal infections after pancreatic transplantation: incidence, treatment, and outcome. J Am Coll Surg 183: 307–316PubMedGoogle Scholar
  12. 12.
    Kusne S, Furukawa H, Abu-Elmagd K, et al (1996) Infectious complications after small bowel transplantation in adults: an update. Transplant Proc 28: 2761–2762PubMedGoogle Scholar
  13. 13.
    Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP (1988) Hospital-acquired candide-mia: the attributable mortality and excess length of stay. Arch Intern Med 148: 2642–2645PubMedCrossRefGoogle Scholar
  14. 14.
    McNeil MM, Nash SL, Hajjeh RA, et al (2001) Trends in mortality due to invasive mycotic diseases in the United States, 1980–1997. Clin Infect Dis 33: 1692–1696CrossRefGoogle Scholar
  15. 15.
    Pfaller MA (1992) Laboratory aids in the diagnosis of invasive candidiasis. Mycopathologia 120: 65–72PubMedCrossRefGoogle Scholar
  16. 16.
    Richardson MD, Kokki MH (1999) New perspectives in the diagnosis of systemic fungal infections. Ann Med 31: 327–335PubMedCrossRefGoogle Scholar
  17. 17.
    Ness MJ, Vaughan WP, Woods GL (1989) Candida antigen latex test for detection of invasive candidiasis in immunocompromised patients. J Infect Dis 159: 495–502PubMedCrossRefGoogle Scholar
  18. 18.
    Walsh TJ, Hathorn JW, Sobel JD, et al (1991) Detection of circulating Candida enolase by immunoassay in patients with cancer and invasive candidiasis. N Engl J Med 324: 10261031Google Scholar
  19. 19.
    Edwards JE (2000) Candida species. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and Practice of Infectious Diseases. Churchill Livingstone, New York, pp 2656–2673Google Scholar
  20. 20.
    Jones JM (1990) Laboratory diagnosis of invasive candidiasis. Clin Micro Rev 3: 32–45PubMedGoogle Scholar
  21. 21.
    Rex JH, Sobel JD (2001) Prophylactic antifungal therapy in the intensive care unit. Clin Infect Dis 32: 1191–2000PubMedCrossRefGoogle Scholar
  22. 22.
    Lin MT, Lu HC, Chen WL (2001) Improving efficacy of antifungal therapy by polymerase chain reaction-based strategy among febrile patients with neutropenia and cancer. Clin Infect Dis 33: 1621–1627PubMedCrossRefGoogle Scholar
  23. 23.
    Petri MG, Konig J, Moecke HP, et al (1997) Epidemiology of invasive mycosis in ICU patients: a prospective multicenter study in 435 non-neutropenic patients. Intensive Care Med 23: 317–325PubMedCrossRefGoogle Scholar
  24. 24.
    Edwards JE, Bodey GP, Bowden RA, et al (1997) International Conference for the development of a consensus on the management and prevention of severe candidal infections. Clin Infect Dis 25: 43–59PubMedCrossRefGoogle Scholar
  25. 25.
    Rex JH, Walsh TJ, Sobel JD, et al (2000) Practice guidelines for the treatment of candidiasis. Clin Infect Dis 30: 662–678PubMedCrossRefGoogle Scholar
  26. 26.
    Evans EGV (1975) The incidence of pathogenic yeast among open-heart surgery patients–the value of prophylaxis. J Thoracic Cardiovasc Surg 70: 466–470Google Scholar
  27. 27.
    Slotman GJ, Burchard KW (1987) Ketoconazole prevents Candida sepsis in critically ill surgical patients. Arch Surg 122: 147–151PubMedCrossRefGoogle Scholar
  28. 28.
    Savino JA, Agarwal N, Wry P, Policastro A, Cerabona T, Austria L (1994) Routine prophylactic antifungal agents (clotrimazole, ketoconazole, and nystatin) in nontransplant/nonburned critically ill surgical and trauma patients. J Trauma 36: 20–26PubMedCrossRefGoogle Scholar
  29. 29.
    Garbino J, Lew D, Romand J-A, Auckenthaler R, Suter P, Pittet D (1997) Fluconazole prevents severe Candida spp infections in high-risk critically ill patients: a randomized, double-blind, placebo-controlled study. In: Program and Abstracts of the 37`h Interscience Conference on Antimicrobial Agents and Chemotherapy. ASM Press, Herndon, pp LM-23bGoogle Scholar
  30. 30.
    Eggimann P, Francioli P, Bille J, et al (1999) Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients. Crit Care Med 27: 1066–1072PubMedCrossRefGoogle Scholar
  31. 31.
    Pelz RK, Hendrix CW, Swoboda SM, et al (2001) Double-blind placebo-controlled trial of fluconazole to prevent candidal infections in critically ill surgical patients. Ann Surg 233: 542–548PubMedCrossRefGoogle Scholar
  32. 32.
    Tollemar J, Hockerstedt K, Ericzon B-G, Jalanko H, Ringden 0 (1995) Liposomal amphotericin B prevents invasive fungal infections in liver transplant recipients: a randomized, placebo-controlled study. Transplantation 59: 45–50Google Scholar
  33. 33.
    Humar A, Kandaswamy R, Granger D, Gruessner RW, Gruessner AC, Sutherland DER (2000) Decreased surgical risks of pancreas transplantation in the modern era. Ann Surg 231: 269–275PubMedCrossRefGoogle Scholar
  34. 34.
    Singh N (2000) Antifungal prophylaxis for solid organ transplant recipients: seeing clarity amidst controversy. Clin Infect Dis 31: 545–553PubMedCrossRefGoogle Scholar
  35. 35.
    Wingard JR, Merz WG, Rinaldi MG, Johnson TR, Karp JE, Saral R (1991) Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. N Engl J Med 325: 1274–1277PubMedCrossRefGoogle Scholar
  36. 36.
    Wingard JR, Merz WG, Rinaldi MG, Miller CB, Karp JE, Saral R (1993) Association of Torulopsis glabrata infections with fluconazole prophylaxis in neutropenic bone marrow transplant patients. Antimicrob Agents Chemother 37: 1847–1849PubMedCrossRefGoogle Scholar
  37. 37.
    Marr KA, Seidel K, Slavin MA, et al (2000) Prolonged fluconazole prophylaxis is associated with persistent protection against candidiasis-related death in allogeneic marrow transplant recipients: long-term follow-up of a randomized, placebo-controlled trial. Blood 96: 2055–2061PubMedGoogle Scholar
  38. 38.
    Marr KA, Seidel K, White TC, Bowden RA (2000) Candidemia in allogeneic blood and marrow transplant recipients: evolution of risk factors after the adoption of prophylactic fluconazole. J Infect Dis 181: 309–316PubMedCrossRefGoogle Scholar
  39. 39.
    Nguyen MH, Peacock JE, Morris AJ, et al (1996) The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance. Am J Med 1900: 617–623CrossRefGoogle Scholar
  40. 40.
    Berrouane YF, Herwaldt LA, Pfaller MA (1999) Trends in antifungal use and epidemiology of nosocomial yeast infections in a university hospital. J Clin Microbiol 37: 531–537.PubMedGoogle Scholar
  41. 41.
    Pfaller MA, Messer SA, Hollis RJ, et al (1999) Trends in species distribution and susceptibility to fluconazole among blood stream isolates of Candida species in the United States. Diagn Microbiol Infect Dis 33: 217–222PubMedCrossRefGoogle Scholar
  42. 42.
    Nguyen MH, Yu CY (1998) Voriconazole against fluconazole-susceptible and resistant Candida isolates: in-vitro efficacy compared to that of itraconazole and ketoconazole. J Antimicrob Chemother 42: 253–256PubMedCrossRefGoogle Scholar
  43. 43.
    Villanueva A, Arathoon EG, Gotuzzo E, Berman RS, DiNubile MJ, Sable CA (2001) A randomized double-blind study of caspofungin versus amphotericin for the treatment of candidal esophagitis. Clin Infect Dis 33: 1529–1535PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • S. L. Sylvester
  • P. Lipsett

There are no affiliations available

Personalised recommendations