INVASIVE CANDIDIASIS IN THE ICU - PATHOGENESIS AND MANAGEMENT STRATEGY

How should new and old antifungals be used in the management of invasi ve candidiasis in ICU patients? A pathogenesis-based management strate gy for invasive candidiasis is outlined. Colonisation of the catheteri sed bladder by Candida species should be eliminated to prevent invasio n from the urinary tract. Invasion from the peritoneum (in the patient with a perforated bowel) should be treated promptly to prevent local Vascular invasion. Empirical therapy is recommended for treatment of s uspected disseminated candidiasis, 'pulmonary' candidiasis and vascula r-access candidiasis. Dose and duration of therapy are decided accordi ng to clinically determined patient/disease categories and modified ac cording to information from laboratory results. Short-term low-bose re gimens are suitable for peritoneal candidiasis that is recognised earl y, and for vascular-access candidiasis, provided the source-catheter c an be removed.