Současné možnosti antimykotické léčby invazivní kandidózy na jednotkách intenzivní péče

SUMMARY Hamal P., Raclavský V., Svobodova L., Koukalova D.: Current options for antifungal therapy of invasive candidiasis in intensive careunitsCandidemia and invasive candidiasis are the most frequent mycoses in critically ill patients in intensive care units. Recently, the num-ber of systemic antifungal agents has increased, leading to improved treatment options. Yet these infections remain to be characteri-zed by poor prognosis and high mortality rates. The most important predisposing factors are yeast colonization of the mucosa or skinand damage to the integrity of the host’s natural barriers. Early diagnosis of invasive candidiasis is difficult, since its clinical manifes-tations are not characteristic and the laboratory techniques are time-consuming and not completely reliable. The currently availabletreatments comprise three groups of antifungals: triazoles, polyenes and echinocandins. For its effectiveness, low toxicity and reaso-nable price, fluconazole is the most widespread drug currently used to treat systemic yeast infections. However, despite high t reatmentcosts, echinocandins are becoming the drug of choice. The advantages are a broad spectrum of species, safe administration to pat ientswith kidney and liver damage, minimal drug interactions and fungicidal effects. Candidemia may often be positively influenced b y re-placing an intravenous catheter. Despite earlier controversy, the latest treatment strategies clearly recommend its removal. Althoughantifungal prophylaxis lowers the incidence of invasive candidiasis, it is considered to be useful only if targeted to high-risk groups ofpatients. Empirical treatment of febrile patients not responding to broad-spectrum antibiotic therapy is only effective in wards witha higher incidence of systemic candidiasis, in patients with risk factors and if other causes are reliably excluded.