Untargeted Antifungal Treatment Strategies for Invasive Candidiasis in Non-neutropenic Critically Ill Patients: Current Evidence and Insights

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Abstract

Purpose of Review: The purpose of this study was to provide an overview and insights on important new concepts on untargeted antifungal treatment strategies, namely prophylaxis pre-emptive and empiric treatments for the management of invasive candidiasis (IC) in non-neutropenic critically ill patients. Recent Findings: Recently, clinical practice guidelines provided recommendation for the management of IC. However, results from recent trials and systematic reviews questioned the effect of untargeted antifungal treatment strategies, especially in terms of survival benefits in non-neutropenic patients, even with septic shock. Summary: Widespread use of untargeted antifungal treatment strategies seems not to be justified anymore. Future research should evaluate comprehensive diagnostic-therapeutic approaches, including the implementation of de-escalation. In the meanwhile, clinicians should take into account all available sources of information including clinical evaluation, risk factor assessment, scores, and surrogate biomarkers to tailor antifungal treatment before definitive microbiological diagnosis.
Lingua originaleEnglish
pagine (da-a)84-91
Numero di pagine8
RivistaCurrent Fungal Infection Reports
Volume11
Stato di pubblicazionePublished - 2017

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Invasive Candidiasis
Critical Illness
Therapeutics
Septic Shock
Practice Guidelines
Biomarkers
Survival

All Science Journal Classification (ASJC) codes

  • Infectious Diseases

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@article{79377cfe9d684957b5e4c808ffe43275,
title = "Untargeted Antifungal Treatment Strategies for Invasive Candidiasis in Non-neutropenic Critically Ill Patients: Current Evidence and Insights",
abstract = "Purpose of Review: The purpose of this study was to provide an overview and insights on important new concepts on untargeted antifungal treatment strategies, namely prophylaxis pre-emptive and empiric treatments for the management of invasive candidiasis (IC) in non-neutropenic critically ill patients. Recent Findings: Recently, clinical practice guidelines provided recommendation for the management of IC. However, results from recent trials and systematic reviews questioned the effect of untargeted antifungal treatment strategies, especially in terms of survival benefits in non-neutropenic patients, even with septic shock. Summary: Widespread use of untargeted antifungal treatment strategies seems not to be justified anymore. Future research should evaluate comprehensive diagnostic-therapeutic approaches, including the implementation of de-escalation. In the meanwhile, clinicians should take into account all available sources of information including clinical evaluation, risk factor assessment, scores, and surrogate biomarkers to tailor antifungal treatment before definitive microbiological diagnosis.",
keywords = "Antifungal treatment, Candida infection, Candidemia, Empiric treatment, Infectious Diseases, Invasive candidiasis, Invasive fungal infection",
author = "Andrea Cortegiani and Antonino Giarratano and Cesare Gregoretti and Raineri, {Santi Maurizio} and Vincenzo Russotto",
year = "2017",
language = "English",
volume = "11",
pages = "84--91",
journal = "Current Fungal Infection Reports",
issn = "1936-3761",
publisher = "Current Science, Inc.",

}

TY - JOUR

T1 - Untargeted Antifungal Treatment Strategies for Invasive Candidiasis in Non-neutropenic Critically Ill Patients: Current Evidence and Insights

AU - Cortegiani, Andrea

AU - Giarratano, Antonino

AU - Gregoretti, Cesare

AU - Raineri, Santi Maurizio

AU - Russotto, Vincenzo

PY - 2017

Y1 - 2017

N2 - Purpose of Review: The purpose of this study was to provide an overview and insights on important new concepts on untargeted antifungal treatment strategies, namely prophylaxis pre-emptive and empiric treatments for the management of invasive candidiasis (IC) in non-neutropenic critically ill patients. Recent Findings: Recently, clinical practice guidelines provided recommendation for the management of IC. However, results from recent trials and systematic reviews questioned the effect of untargeted antifungal treatment strategies, especially in terms of survival benefits in non-neutropenic patients, even with septic shock. Summary: Widespread use of untargeted antifungal treatment strategies seems not to be justified anymore. Future research should evaluate comprehensive diagnostic-therapeutic approaches, including the implementation of de-escalation. In the meanwhile, clinicians should take into account all available sources of information including clinical evaluation, risk factor assessment, scores, and surrogate biomarkers to tailor antifungal treatment before definitive microbiological diagnosis.

AB - Purpose of Review: The purpose of this study was to provide an overview and insights on important new concepts on untargeted antifungal treatment strategies, namely prophylaxis pre-emptive and empiric treatments for the management of invasive candidiasis (IC) in non-neutropenic critically ill patients. Recent Findings: Recently, clinical practice guidelines provided recommendation for the management of IC. However, results from recent trials and systematic reviews questioned the effect of untargeted antifungal treatment strategies, especially in terms of survival benefits in non-neutropenic patients, even with septic shock. Summary: Widespread use of untargeted antifungal treatment strategies seems not to be justified anymore. Future research should evaluate comprehensive diagnostic-therapeutic approaches, including the implementation of de-escalation. In the meanwhile, clinicians should take into account all available sources of information including clinical evaluation, risk factor assessment, scores, and surrogate biomarkers to tailor antifungal treatment before definitive microbiological diagnosis.

KW - Antifungal treatment

KW - Candida infection

KW - Candidemia

KW - Empiric treatment

KW - Infectious Diseases

KW - Invasive candidiasis

KW - Invasive fungal infection

UR - http://hdl.handle.net/10447/273012

M3 - Article

VL - 11

SP - 84

EP - 91

JO - Current Fungal Infection Reports

JF - Current Fungal Infection Reports

SN - 1936-3761

ER -