EPIDEMIOLOGY, DIAGNOSIS AND TREATMENT OF SYSTEMIC CANDIDA INFECTION IN SURGICAL PATIENTS UNDER INTENSIVE-CARE

The incidence of systemic Candida infections in patients requiring int ensive care has increased substantially in recent years as a result of a combination of factors. More patients with severe underlying diseas e or immunosuppression from anti-neoplastic or anti-rejection chemothe rapy and at risk from fungal infection are now admitted to the ICU. Im provements in supportive medical and surgical care have led to many pa tients who would previously have died as a result of trauma or disease surviving to receive intensive care. Moreover, some therapeutic inter ventions used in the ICU, most notably broad-spectrum antibiotics and intravascular catheters, are also associated with increased risks of c andidiasis. Systemic Candida infections are associated with a high mor bidity and mortality, but remain difficult to diagnose and ICU staff n eed to be acutely aware of this often insidious pathogen. A number of studies have identified risk factors for systemic Candida infection wh ich may be used to identify those at highest risk. Such patients may b e potential candidates for early, presumptive therapy. Here we review the epidemiology, pathogenesis, morbidity and mortality of systemic Ca ndida infections in the ICU setting, and examine predisposing risk fac tors. Antifungal treatment, including the use of amphotericin B, flucy tosine and fluconazole, and the roles of early presumptive therapy and prophylaxis, is also reviewed.