Candidemia in Adult Patients in the ICU: A Reappraisal of Susceptibility Testing and Antifungal Therapy.

Autor:	Chastain DB; Department of Clinical & Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA., White BP; University of Oklahoma Health Medical Center, Oklahoma City, OK, USA., Tu PJ; Charlie Norwood VA Medical Center, Augusta, GA, USA., Chan S; Department of Clinical & Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA.; Department of Pharmacy, Phoebe Putney Memorial Hospital, Albany, GA, USA., Jackson BT; Mount Sinai Morningside, New York, NY, USA., Kubbs KA; University of Oklahoma Health Medical Center, Oklahoma City, OK, USA., Bandali A; Overlook Medical Center, Atlantic Health System, Summit, NJ, USA., McDougal S; University of Utah Hospital, Salt Lake City, UT, USA., Henao-Martínez AF; Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Cluck DB; Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA.
Jazyk:	angličtina
Zdroj:	The Annals of pharmacotherapy [Ann Pharmacother] 2024 Mar; Vol. 58 (3), pp. 305-321. Date of Electronic Publication: 2023 Jun 05.
DOI:	10.1177/10600280231175201
Abstrakt:	Objective: To provide updates on the epidemiology and recommendations for management of candidemia in patients with critical illness. Data Sources: A literature search using the PubMed database (inception to March 2023) was conducted using the search terms "invasive candidiasis," "candidemia," "critically ill," "azoles," "echinocandin," "antifungal agents," "rapid diagnostics," "antifungal susceptibility testing," "therapeutic drug monitoring," "antifungal dosing," "persistent candidemia," and "Candida biofilm." Study Selection/data Extraction: Clinical data were limited to those published in the English language. Ongoing trials were identified through ClinicalTrials.gov. Data Synthesis: A total of 109 articles were reviewed including 25 pharmacokinetic/pharmacodynamic studies and 30 studies including patient data, 13 of which were randomized controlled clinical trials. The remaining 54 articles included fungal surveillance data, in vitro studies, review articles, and survey data. The current 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Management of Candidiasis provides recommendations for selecting empiric and definitive antifungal therapies for candidemia, but data are limited regarding optimized dosing strategies in critically ill patients with dynamic pharmacokinetic changes or persistent candidemia complicated. Relevance to Patient Care and Clinical Practice: Outcomes due to candidemia remain poor despite improved diagnostic platforms, antifungal susceptibility testing, and antifungal therapy selection for candidemia in critically ill patients. Earlier detection and identification of the species causing candidemia combined with recognition of patient-specific factors leading to dosing discrepancies are crucial to improving outcomes in critically ill patients with candidemia. Conclusions: Treatment of candidemia in critically ill patients must account for the incidence of non-albicans Candida species and trends in antifungal resistance as well as overcome the complex pathophysiologic changes to avoid suboptimal antifungal exposure. Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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