Antifungal Management

  • S. Rinaldi
  • A. R. De Gaudio


During the last 2 decades, an increased frequency of severe life-threatening infections caused by yeasts has been reported in critical ICU patients [1]. The two main factors contributing to yeast infections are: the disregulation of immune system and the alteration of microbial flora secondary to extensive use of broad-spectrum antibiotics. Critically ill patients exhibit a complex change in immune function characterized by deactivation of macrophages and altered cellular response with shift from Th1 to Th2 response [1, 2]. Many other factors impairing the immune function during critical illness include hyperglycemia and the use of corticosteroids [2]. In particular, corticosteroids have profound effects on the distribution and function of neutrophils, monocytes, and lymphocytes and they directly stimulate the growth of some yeasts like Aspergillus fumigatus that have sterol binding proteins [2]. In ICU the two main fungal species involved in severe invasive infections are Candida spp. and Aspergillus spp., while Cryptococcus spp. remains a significant pathogen only in patients with severe immunodepression like those affected by HIV [1]. Invasive candidiasis affects around 2% of ICU patients in the USA, causing around 10% of ICU-acquired bloodstream infections and representing the third commonest blood-stream pathogen [1]. However, the epidemiology of candidemia depends upon geographic region, ICU type, and case mix. The crude mortality associated with candidemia ranges between 40 and 70%, depending on the severity of the underlying disease, while attributable mortality estimates vary between 20 to 50% from retrospective studies and 5–7% from prospective clinical trials [3].


Antifungal Therapy Invasive Aspergillosis Invasive Fungal Infection Invasive Candidiasis Candida Infection 
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Copyright information

© Springer-Verlag Italia 2009

Authors and Affiliations

  • S. Rinaldi
    • 1
  • A. R. De Gaudio
    • 1
  1. 1.Department of Critical Care, Section of Anesthesiology and Intensive CareUniversity of FlorenceFlorenceItaly

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