Fungal infections in critically ill patients

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7103.266 (Published 02 August 1997) Cite this as: BMJ 1997;315:266

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Rates are rising but diagnosis and treatment remain difficult

  1. Jeffrey Lipman, Heada,
  2. Roger Saadia, Professor of surgeryb
  1. a Intensive Care Unit, Baragwanath Hospital, PO Bertsham, 2013 Johannesburg, South Africa
  2. b Medical School, 7 York Road, Parktown, 2193 Johannesburg, South Africa

    The microbial threat posed by nosocomial fungal infections in critically ill patients has become increasingly apparent in the past 30-40 years.1 Fungi (predominantly candida species) are now among the most frequently isolated organisms in intensive care units. Two years ago, Pittet and Wenzel reported a 12-fold rise in the reported rate of candida infections in a 12 year study of over 250 000 patients.2 This trend has been confirmed in other studies in the United States3 as well as in Europe.4 The species identified most often has been Candida albicans, but other species (notably Torulopsis glabrata and Candida tropicalis) are being isolated ever more often and are associated with more complications and a higher mortality.5

    Making a diagnosis of candidiasis may often be difficult, but the risk factors are well known and most are commonly found in intensive care units. The presence of one or more risk factors should heighten clinical suspicion. Treatment with broad spectrum antibiotics (and so suppressing the normal intestinal flora6) is the single most important factor …

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