Fungal Infections: The Role of Prophylaxis and Empiric Therapy in ICU Patients

It has been shown in the last decade that the incidence of nosocomial fungal infections is increasing both in the USA (1) and in European hospitals (2,3). In the ICU setting Candida species are the most common cause of invasive fungal infections. The increase in nosocomial invasive candidosis parallels the advance made in the medical and surgical supportive care towards survival of critically ill patients, which would previously have died of severe illness. One of the most important risk factors for development of invasive fungal infections in these debilitated patients is the enormous increase in appropriate or in-appropriate use of broad spectrum antibiotics. Carefully considered presumptive treatment of infectious diseases in the ICU prior to establishment of a diagnosis is a common and proper practice of medicine. However ill-considered use of antibiotics can lead to a spiraling empiricism of antibiotic therapy incurring unnecessary risk of side effects and ultimately fungal infections (4). Their modulation of the bacterial flora induces an overgrowth of gastrointestinal Candida colonization which is a major first step in the development of invasive candidosis. It is an important task for the ICU physician to prevent development of invasive fungal infections because of its high attributable mortality. Appropriate use of broad spectrum antibiotics, strict hygienic measures and preemptive treatment with antimycotics in a certain subset of ICU patients with identified risk factors should prove essential to decrease the number of patients with invasive fungal disease. Neutropenic patients and transplant recipients is a distinct group with regard