Fungal Sepsis in the Critically Ill

• 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 Clin 2011; 27:123-147.