FUNGAL INFECTION IN SURGICAL PATIENTS

Invasive fungal infections have become a major source of morbidity and mortality in the modern surgical intensive care unit. Patients at ris k for invasion and dissemination are common, and are not as ill as tho ught previously. Severity of illness (APACHE II score >10, ventilator use for >48 hours), antibiotics, central venous lines, total parentera l nutrition, burns, and immunosuppression are the most common risk fac tors. Recognition of these risk factors should arouse a high index of suspicion for the diagnosis of invasion or dissemination. Unfortunatel y, laboratory tests alone lack sensitivity and specificity. Therefore, the diagnosis of invasion and dissemination in the majority of cases requires the acquisition and proper interpretation of clinical evidenc e. Once the diagnosis is made, early systemic treatment is warranted. Reported toxicity and efficacy supports the use of fluconazole for mos t patients with invasive fungal infections, However, for the most crit ically ill patient amphotericin B remains the treatment of choice.