Fungal infections have been increasing at an alarming rate in critically ill patients. Candida is now the fourth most common pathogen isolated from the bloodstream and is associated with significant morbidity, mortality, and economic consequences. Novel antifungals have been developed in recent years to provide alternatives to amphotericin B, which continues to be the standard therapy for most invasive fungal infections. These alternatives include lipid-based amphotericin B, ketoconazole, fluconazole, itraconazole, caspofungin, and potentially voriconazole. Optimal therapy for the various forms of candidiasis remains controversial. A standardized antifungal susceptibility testing method for Candida isolates has been developed to assist drug selection, but its clinical relevance remains to be determined. The relative susceptibility of Candida isolates can be estimated by the species. Specifically, C krusei is resistant to azoles, C glabrata may be resistant to azoles, and C lusitaniae may be resistant to amphotericin B Candida infections can affect any organ system, and the diagnosis of such infections remains difficult. The Infectious Diseases Society of America recently developed guidelines for the management of candidiasis. This review includes a brief discussion of systemically administered antifungal agents and provides a synopsis of the practice guidelines for the management of candidiasis.
Banerjee SN, Emori TG, Culver DH, et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. Am J Med. 1991;91(suppl 3B):86S-89S.
2.
Beck-Sague CM, Jarvis WR, and the National Nosocomial Infections Surveillance System. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. J Infect Dis. 1993;167:1247-1251.
3.
Pfaller MA, Jones RN, Messer SA, et al. National surveillance of nosocomial bloodstream infections due to Candida albicans: frequency of occurrence and antifungal susceptibility in the SCOPE program. Diagn Microbiol Infect Dis. 1998;30:121-129.
4.
Wey SB, Mori M, Pfaller MA, et al. Risk factors for hospital-acquired candidemia. A matched case-control study. Arch Intern Med. 1989;149:2349-2353.
5.
Rex JH, Bennett JE, Sugar AM, et al. Intravascular catheter exchange and duration of candidemia. Clin Infect Dis. 1995;21:994-996.
Wey SB, Mori M, Pfaller MA, et al. Hospital-acquired candidemia. The attributable mortality and excess length of stay. Arch Intern Med. 1988;148:2642-2645.
8.
Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA. 1994;271:1598-1601.
9.
Dismukes WE. Introduction to antifungal drugs. Clin Infect Dis. 2000;30:653-657.
10.
Rex JH, Walsh TJ, Sobel JD, et al. Practice guidelines for the treatment of candidiasis. Clin Infect Dis. 2000;30:662-678.
11.
Saag MA, Graybill RJ, Larsen RA. Practice guidelines for the management of cryptococcal disease. Clin Infect Dis. 2000;30:710-718.
12.
Stevens DA, Kan VL, Judson MA, et al. Practice guidelines for diseases caused by Aspergillus. Clin Infect Dis. 2000;30:696-709.
13.
Wheat J, Sarosi G, McKinsey D, et al. Practice guidelines for the management of patients with histoplasmosis. Clin Infect Dis. 2000;30:688-695.
14.
Chapman SW, Bradsher RW, Campbell GD, et al. Practice guidelines for the management of patients with blastomycosis. Clin Infect Dis. 2000;30:679-683.
15.
Galgiani JN, Ampel NM, Catanzaro A, et al. Practice guidelines for the treatment of coccidiodomycosis. Clin Infect Dis. 2000;30:658-661.
16.
Kauffman CA, Hajjeh R, Chapman SW. Practice guidelines for the management of patients with sporotrichosis. Clin Infect Dis. 2000;30:684-687.
17.
Kauffman CA, Carver PL. Antifungal agents in the 1990s: current status and future developments. Drugs. 1997;53(4):539-549.
18.
Walsh TJ, Viviani MA, Arathoon E, et al. New targets and delivery systems for antifungal therapy. Med Mycol. 2000;38(suppl 1):335-347.
19.
Hann IM, Prentice HG. Lipid-based amphotericin B: a review of the last 10 years of use. Int J Antimicrob Agents. 2001;17:161-169.
20.
Wingard JR, White MH, Anaissie E, et al. A randomized, double-blind comparative trial evaluating the safety of lipososmal amphotericin B versus amphotericin B lipid complex in the empirical treatment of febrile neutropenia. Clin Infect Dis. 2000;31:1155-1163.
21.
Bennett J.Editorial response: choosing amphotericin B formulations-between a rock and a hard place. Clin Infect Dis. 2000;31:1164-1165.
22.
Sabo JA, Abdel-Rahman SM. Voriconazole: a new triazole antifungal. Ann Pharmacother. 2000;34:1032-1043.
Price MF, LaRocco MT, Gentry LO. Fluconazole susceptibilities of Candida species and distribution of species recovered from blood cultures over a 5 year period. Antimicrob Agents Chemother. 1994;38:1422-1424.
25.
Fisher MA, Shen SH, Haddad J, et al. Comparison of in vivo activity of fluconazole with that of amphotericin B against Candida tropicalis, Candida glabrata, and Candida krusei. Antimicrob Agents Chemother. 1989;33:1443-1446.
26.
National Committee for Clinical Laboratory Standards (NCCLS). Reference method for broth dilution antifungal susceptibility testing of yeasts: approved standard. NCCLS document M27-A. Wayne, PA: NCCLS; 1997.
27.
Revankar SG, Kirkpatrick WR, McAtee RK, et al. A randomized trial of continuous or intermittent therapy with fluconazole for oropharyngeal candidiasis in HIV-infected patients: clinical outcomes and development of fluconazole resistance. Am J Med. 1998;105:7-11.
28.
Yoon SA, Vazquez JA, Steffan PE, et al. High-frequency in vitro reversible switching of Candida lusitaniae clinical isolates from amphotericin B susceptibility to resistance. Antimicrob Agents Chemother. 1999;43:836-845.
29.
Sugar AM. Problems in the diagnosis of invasive candidiaisis in the immunocompromised patient. In: Richardson RG, ed. Opportunistic infections: Focus on Fluconazole. Royal Society of Medicine Services International Congress and Symposium Series. London, England, Royal Society of Medicine Services Limited, 1989;153:17-24.
30.
Lecciones JA, Lee JW, Navarro EE, et al. Vascular catheter-associated fungemia in patients with cancer: analysis of 155 episodes. Clin Infect Dis. 1992;14:875-883.
31.
Rex JH, Bennett JE, Sugar AM, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. N Engl J Med. 1994;331:1325-1330.
32.
Phillips P, Shafran S, Garber G, et al. Multicenter randomized trial of fluconazole with amphotericin B for the treatment of candidemia in non-neutropenic patients. Eur J Clin Microbiol Infect Dis. 1997;16:337-345.
33.
Walsh TJ, Hiemenz JW, Seibel NL, et al. Amphotericin B lipid complex for invasive fungal infections: analysis of safety and efficacy in 556 cases. Clin Infect Dis. 1998;26:1383-1396.
34.
Nguyen MH, Peacock JE, Tanner DC, et al. Therapeutic approaches in patients with candidemia: evaluation in a multicenter, prospective, observational study. Arch Intern Med. 1995;155:2429-2435.
35.
Kelsey SM, Goldman JM, McCann S, et al. Liposomal amphotericin (ambisome) in the prophylaxis of fungal infections in neutropenic patients: a randomized, placebo-controlled study. Bone Marrow Transplant. 1999;23:163-168.
36.
Wingard JR. Importance of Candida species other than C. albicans as pathogens in oncology patients. Clin Infect Dis. 1995;20:115-125.
37.
Kauffman CA, Bradley SF, Ross SC, et al. Hepatosplenic candidiasis: successful treatment with fluconazole. AmJMed. 1991;91:137-141.
38.
Anaissie E, Bodey GP, Kantarjian H, et al. Fluconazole therapy for chronic disseminated candidiasis in patients with leukemia and prior amphotericin B therapy. AmJMed. 1991;91:142-150.
39.
Faix RG. Invasive neonatal candidiasis: comparison of albicans and parapsilosis infection. Pediatr Infect Dis J. 1992;11:88-93.
40.
van der Anker JN, van Popele NM, Sauer PJ. Antifungal agents in neonatal systemic candidiasis. Antimicrob Agents Chemother. 1995;39:1391-1397.
41.
Gubbins PO, Piscitelli SC, Danziger LH. Candidal urinary tract infections: a comprehensive review of their diagnosis and management. Pharmacotherapy. 1993;13:110-127.
42.
Jacobs LG, Skidmore EA, Freeman K, et al. Oral fluconazole compared with bladder irrigation with amphotericin B for treatment of fungal urinary tract infections in elderly patients. Clin Infect Dis. 1996;22:30-35.
43.
Haron E, Vartivarian S, Anaissie E, et al. Primary Candida pneumonia: experience at a large cancer center and review of the literature. Medicine. 1993;72:137-142.
44.
Wang JN, Liu CC, Huang TZ, et al. Laryngeal candidiasis in children. Scand J Infect Dis. 1997;29:427-429.
45.
Ferra C, Doebbeling BN, Hollis RJ, et al. Candida tropicalis vertebral osteomyelitis: a late sequela of fungemia. Clin Infect Dis. 1994;19:697-703.
46.
Hennequin C, Bouree P, Hiesse C, et al. Spondylodiskitis due to Candida albicans: report of two patients who were successfully treated with fluconazole and review of the literature. Clin Infect Dis. 1996;23:176-178.
47.
Tunkel AR, Thomas CY, Wispelwey B.Candida prosthetic arthritis: report of a case treated with fluconazole and a review of the literature. AmJMed. 1993;94:100-103.
48.
Eggiman P, Francioli P, Bille J, et al. Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients. Crit Care Med. 1999;27:1066-1072.
49.
Johnston P, lee J, Demanski M, et al. Late recurrent Candida endocarditis. Chest. 1991;99:1531-1533.
50.
Smego RA, Perfect JR, Durack DT. Combined therapy with amphotericin B and 5-fluorocytosine for Candida meningitis. Rev Infect Dis. 1984;6:791-801.
51.
Martinez-Vasquez C, Fernandez-Ulloa J, Bordon J, et al. Candida albicans endopthalmitis in brown heroin addicts: response to early vitrectomy preceded and followed by antifungal therapy. Clin Infect Dis. 1998;27:1130-1133.
52.
Wilcox CM, Dariouche RO, Laine L, et al. A randomized, double-blind comparison of itraconazole oral solution and fluconazole tablets in the treatment of esophageal candidiasis. J Infect Dis. 1997;176:227-232.
53.
Slavin MA, Osborne B, Adams R, et al. Efficacy and safety of fluconazole prophylaxis for fungal infections after bone marrow transplantation: a prospective, randomized, double-blind study. J Infect Dis. 1995;171:1545-1552.
54.
Collins LA, Samore MH, Roberts MS, et al. Risk factors for invasive fungal infections complicating orthotopic liver transplantation. J Infect Dis. 1994;170:644-652.
55.
Benedetti E, Gruessner AC, Troppmann C, et al. Intra-abdominal fungal infections after pancreatic transplantation: incidence, treatment, and outcome. J Am Coll Surg. 1996;183:307-316.
