Invasive fungal infections (IFIs) are documented in critically ill, non-neutropenic patients, in intensive care units (ICUs) and surgical wards, but also in non critical patients cared for in medical wards.
Candida spp. infections mainly occur in patients undergone to major abdominal surgery, receiving broad spectrum antibiotic therapy and after a long ICU stay. A more favorable outcome is reported for fungemia due to C. parapsilosis; the worse prognosis is associated with C. tropicalis infections.
Any delay in starting an appropriate antifungal treatment is associated with an increase in mortality rate of candidemia. When used as empirical therapy, fluconazole did not show any superiority to placebo and was inferior to anidulafungin in the treatment of documented candidemia/invasive candidiasis. ECCMID guidelines emphasize the role of echinocandins and, as a reliable alternative, suggest the use of liposomal Amphotericin B. Although with more nephrotoxicity with respect to echinocandins, Amphotericin B showed a systematic fungicidal and anti-biofilm activity against C. albicans and non-albicans species.
Invasive Aspergillosis have been also reported in non neutropenic patients with chronic obstructive pulmonary disorders receiving steroid therapy for respiratory failure, in pts with severe liver failure and in solid organ transplant patients. Treatment of choice for Invasive Aspergillosis is represented by Voriconazole, but liposomal Amphotericin B represents a reliable alternative when azole use is contraindicated.
Articolo presente in – HAART and correlated pathologies n. 17 –