期刊
CLINICAL MICROBIOLOGY AND INFECTION
卷 18, 期 -, 页码 19-37出版社
ELSEVIER SCI LTD
DOI: 10.1111/1469-0691.12039
关键词
Candidiasis; Guideline; non-neutropenic; prophylaxis; treatment
资金
- German Federal Ministry of Research and Education (BMBF) [01KN1106]
- Pfizer
- MSD
- Astellas
- Baxter
- bioMerieux
- Merck Sharp
- Dohme-Chibret AG
- Roche Diagnostic
- Institut Pasteur
- Gilead Sciences
- Bio-Merieux
- Cephalon
- Merck
- Gilead
- Astellas Pharma
- Merck Sharp and Dohme
- Schering Plough
- Soria Melguizo SA
- Ferrer International
- European Union
- ALBAN program
- Spanish Agency for International Cooperation
- Spanish Ministry of Culture and Education
- Spanish Health Research Fund
- Instituto de Salud Carlos III
- Ramon Areces Foundation
- Mutua Madrilena Foundation
- Schering
- National Institute of Health Research (NIHR)
- Medical Research Council
- National Institute for the Replacement, Refinement and Reduction, of Animals in Research
- Astra Zeneca
- Novartis
- GSK
- Schering-Plough
- Abbott
- BMS
- MSD (Schering-Plough)
- National Institute for Health Research [CS/08/08/10] Funding Source: researchfish
Clin Microbiol Infect 2012; 18 (Suppl. 7): 1937 Abstract This part of the EFISG guidelines focuses on non-neutropenic adult patients. Only a few of the numerous recommendations can be summarized in the abstract. Prophylactic usage of fluconazole is supported in patients with recent abdominal surgery and recurrent gastrointestinal perforations or anastomotic leakages. Candida isolation from respiratory secretions alone should never prompt treatment. For the targeted initial treatment of candidaemia, echinocandins are strongly recommended while liposomal amphotericin B and voriconazole are supported with moderate, and fluconazole with marginal strength. Treatment duration for candidaemia should be a minimum of 14 days after the end of candidaemia, which can be determined by one blood culture per day until negativity. Switching to oral treatment after 10 days of intravenous therapy has been safe in stable patients with susceptible Candida species. In candidaemia, removal of indwelling catheters is strongly recommended. If catheters cannot be removed, lipid-based amphotericin B or echinocandins should be preferred over azoles. Transoesophageal echocardiography and fundoscopy should be performed to detect organ involvement. Native valve endocarditis requires surgery within a week, while in prosthetic valve endocarditis, earlier surgery may be beneficial. The antifungal regimen of choice is liposomal amphotericin B +/- flucytosine. In ocular candidiasis, liposomal amphotericin B +/- flucytosine is recommended when the susceptibility of the isolate is unknown, and in susceptible isolates, fluconazole and voriconazole are alternatives. Amphotericin B deoxycholate is not recommended for any indication due to severe side effects.
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