Intensive care medicine research agenda on invasive fungal infection in critically ill patients. [Review]

MedStar author(s):
Citation: Intensive Care Medicine. 43(9):1225-1238, 2017 Sep.PMID: 28255613Department: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Antifungal Agents/pd [Pharmacology] | *Candidemia | *Invasive Pulmonary Aspergillosis | *Standard of Care/st [Standards] | Antibodies, Fungal/bl [Blood] | Antifungal Agents/tu [Therapeutic Use] | Aspergillus/im [Immunology] | Aspergillus/ip [Isolation & Purification] | Biomarkers/bl [Blood] | Biomedical Research | Candida/im [Immunology] | Candida/ip [Isolation & Purification] | Candidemia/di [Diagnosis] | Candidemia/dt [Drug Therapy] | Candidemia/mo [Mortality] | Candidemia/pc [Prevention & Control] | Critical Illness/mo [Mortality] | Global Health | Humans | Incidence | Intensive Care Units | Invasive Fungal Infections/dg [Diagnostic Imaging] | Invasive Fungal Infections/dt [Drug Therapy] | Invasive Fungal Infections/mo [Mortality] | Invasive Fungal Infections/pc [Prevention & Control] | Invasive Pulmonary Aspergillosis/di [Diagnosis] | Invasive Pulmonary Aspergillosis/dt [Drug Therapy] | Invasive Pulmonary Aspergillosis/mo [Mortality] | Invasive Pulmonary Aspergillosis/pc [Prevention & Control] | Practice Guidelines as Topic | Randomized Controlled Trials as Topic | Risk FactorsYear: 2017Local holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library:2002-2007ISSN:
  • 0342-4642
Name of journal: Intensive care medicineAbstract: CONCLUSIONS: Fundamental questions regarding IFI have to be addressed over the next decade. The clinical studies described in this research agenda should provide a template and set priorities for the clinical investigations that need to be performed.METHODS: A systematic review of the medical literature taking account of national and international guidelines and expert opinion.PURPOSE: To describe concisely the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to Candida and Aspergillus infections in non-neutropenic patients in the ICU setting.RESULTS: Severe invasive fungal infections (IFIs) are becoming increasingly frequent in critically ill patients. Approximately 80% of IFIs are due to Candida spp. and 0.3-19% to Aspergillus spp. Recent observations emphasize the necessity of building a worldwide sentinel network to monitor the emergence of new fungal species and changes in susceptibility. Robust data on the attributable mortality are essential for the design of clinical studies with mortality endpoints. Although early antifungal therapy for Candida has been recommended in patients with risk factors, sepsis of unknown cause, and positive Candida serum biomarkers [beta-1 -> 3-D-glucan (BDG) and Candida albicans germ tube antibody (CAGTA)], its usefulness and influence on outcome need to be confirmed. Future studies may specifically address the optimal diagnostic and therapeutic strategies for patients with abdominal candidiasis. Better knowledge of the pharmacokinetics of antifungal molecules and tissue penetration is a key issue for intensivists. Regarding invasive aspergillosis, further investigation is needed to determine its incidence in the ICU, its relationship with influenza outbreaks, the clinical impact of rapid diagnosis, and the significance of combination treatment.All authors: Azoulay E, Bassetti M, Calandra T, Chakrabarti A, Cornely OA, Dimopoulos G, Garnacho-Montero J, Kett D, Kullberg B, Leon C, Ostrosky-Zeichner L, Richardson MD, Sanguinetti M, Shorr A, Timsit JFFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2017-05-06
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 28255613 Available 28255613

Available online from MWHC library: 1997 - present, Available in print through MWHC library:2002-2007

CONCLUSIONS: Fundamental questions regarding IFI have to be addressed over the next decade. The clinical studies described in this research agenda should provide a template and set priorities for the clinical investigations that need to be performed.

METHODS: A systematic review of the medical literature taking account of national and international guidelines and expert opinion.

PURPOSE: To describe concisely the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to Candida and Aspergillus infections in non-neutropenic patients in the ICU setting.

RESULTS: Severe invasive fungal infections (IFIs) are becoming increasingly frequent in critically ill patients. Approximately 80% of IFIs are due to Candida spp. and 0.3-19% to Aspergillus spp. Recent observations emphasize the necessity of building a worldwide sentinel network to monitor the emergence of new fungal species and changes in susceptibility. Robust data on the attributable mortality are essential for the design of clinical studies with mortality endpoints. Although early antifungal therapy for Candida has been recommended in patients with risk factors, sepsis of unknown cause, and positive Candida serum biomarkers [beta-1 -> 3-D-glucan (BDG) and Candida albicans germ tube antibody (CAGTA)], its usefulness and influence on outcome need to be confirmed. Future studies may specifically address the optimal diagnostic and therapeutic strategies for patients with abdominal candidiasis. Better knowledge of the pharmacokinetics of antifungal molecules and tissue penetration is a key issue for intensivists. Regarding invasive aspergillosis, further investigation is needed to determine its incidence in the ICU, its relationship with influenza outbreaks, the clinical impact of rapid diagnosis, and the significance of combination treatment.

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