The risk of fungal infections in the ICU. Epidemiology, diagnosis and treatment

N. Mircea, L. Horhotă
Secţia ATI, Spitalul Clinic Colţea, Bucureşti

Abstract

The incidence of invasive fungal infections has increased in immunocompromised patients with haematological malignancies, AIDS or chemo-therapy, but also in immunocompetent patients in the ICU. The risk factors are the insertion of intra-vascular devices or urinary and intraperitonealy catheters, a long term antibiotic therapy and mechanical ventilation. Stratification of risk factors is difficult. Diagnosis of systemic fungal infections is problematic and many infections are confirmed only at autopsy. The treatment which should be intensive and involve second generation triazoles, amphotericin B or echinocandine antifungal agents is probably life saving.
The authors’ personal experience, 6 cases of invasive fungal infections, were observed over a period of 12 years (1992-2004) in patients with acute leukaemia undergoing chemotherapy, corticosteroid and antibiotic therapy. The diagnosis was established on positive haemocultures after the patients’ deaths, during the first 24 hours of their admission in ICU.

Key words: candida, aspergillus, antifungal agents, intensive care unit

ACTUALIZĂRI
Riscul infecţiilor cu fungi în terapia intensivă - aspecte epidemiologice, diagnostice şi terapeutice*

Jurnalul Român de Anestezie Terapie intensivă 2004 Vol.11 Nr.2, 117-124