In recent years, the incidence of invasive fungal infections has risen dramatically.
Candida species (C. albicans, C. glabrata, C. parapsilosis, C tropicalis, C. krusei) account for the majority of invasive infections in the critically ill patient.
Key risk factors for invasive candidal infections include:
Exposure to broad spectrum antibiotics
Cancer chemotherapy
Indwelling catheters
TPN administration
Neutropenia
Hemodialysis
Given the significant mortality of invasive fungal infections, early and appropriate antifungal therapy is paramount.
First-line empiric antifungal therapy recommendations from the Infectious Disease Society of America include caspofungin, micafungin, or fluconazole. Amphotericin B is now reserved for patients who are either intolerant or not responding to the echinocandins (caspofungin, micafungin).
References
Lepak A, Andes D. Fungal sepsis: Optimizing antifungal therapy in the critical care setting. Crit Care Clin2011; 27:123-147.
