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Review
. 2012 Jun;39(6):464-71.
doi: 10.1016/j.ijantimicag.2011.11.017. Epub 2012 Feb 14.

Invasive fungal infections in patients with cancer in the Intensive Care Unit

Nikolaos V Sipsas  1 , Dimitrios P Kontoyiannis
Affiliations
Review

Invasive fungal infections in patients with cancer in the Intensive Care Unit

Nikolaos V Sipsas et al. Int J Antimicrob Agents. 2012 Jun.

Abstract

Invasive fungal infections (IFIs) have emerged as a major cause of morbidity and mortality amongst critically ill patients. Cancer patients admitted to the Intensive Care Unit (ICU) have multiple risk factors for IFIs. The vast majority of IFIs in the ICU are due to Candida spp. The incidence of invasive candidiasis (IC) has increased over recent decades, especially in the ICU. A shift in the distribution of Candida spp. from Candida albicans to non-albicans Candida spp. has been observed both in ICUs and oncology units in the last two decades. Timely diagnosis of IC remains a challenge despite the introduction of new microbiology techniques. Delayed initiation of antifungal therapy is associated with increased mortality. Therefore, prediction rules have been developed and validated prospectively in order to identify those ICU patients at high risk for IC and likely to benefit from early treatment. These rules, however, have not been validated in cancer patients. Similarly, major clinical studies on the efficacy of newer antifungals typically do not include cancer patients. Despite the introduction of more potent and less toxic antifungals, mortality from IFIs amongst cancer patients remains high. In recent years, aspergillosis and mucormycosis have also emerged as significant causes of morbidity and mortality amongst ICU patients with haematological cancer.

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Conflict of interest statement

Competing interests

NVS declares no competing conflicts

Figures

Fig. 1
Fig. 1
Effect of disease severity, expressed as Acute Physiology and Chronic Health Evaluation II (APACHE II) score, on antifungal treatment success in patients with invasive candidiasis. Intervention with combination therapy is effective when applied early. AmB-d 0.7, amphotericin B deoxycholate 0.7 mg/kg/day; FLU 800, fluconazole 800 mg/day. Adapted from Rex et al. [68].
Fig. 2
Fig. 2
Timing of initiation of antifungals and mortality rates among cancer patients with invasive candidiasis. PCR, polymerase chain reaction.
Fig. 3
Fig. 3
Factors associated with increased mortality in intensive care unit cancer patients. APACHE II, Acute Physiology and Chronic Health Evaluation II score.
See this image and copyright information in PMC

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