Solís-Ayala E, García-González AC, Vicente-Hernández B, Rodríguez-Weber F, Díaz-Greene E

Language: Spanish
References: 14
Page: 425-434
PDF size: 451.33 Kb.

ABSTRACT

Candida spp is the fourth most frequent isolated pathogen in patients in intensive care units associated with burns, abdominal surgery, organ transplants and bone marrow among others. It is a commensal that inhabits the intestinal and mucocutaneous surfaces. Colonization with Candida spp precedes and increases the risk of severe infections in patients at high risk, with invasive candidiasis a major cause of complications and death. Current treatment options include fluconazole, caspofungin, voriconazole and amphotericin B. The echinocandins have emerged as agents in the management of invasive candidiasis, with adequate safety profile and spectrum against other Candida species, the delay in treatment can be fatal. The risk factors are: the use of central venous catheters, total parenteral nutrition, antibiotic therapy, extensive surgery, burns, kidney failure, mechanical ventilation, previous fungal infection with Candida spp, this being particularly important since the probability of Candida infection in the absence of previous colonization is very low. This paper reviews the literature, among which were meta-analyses and randomized clinical trials that found that prophylactic antifungal therapy reduces the incidence of Candida infections, fluconazole being recommended by the Infectious Diseases Society of America guidelines, with a moderate to high level of evidence for selectively preventing invasive candidiasis in high-risk patients. The caspofungin may be effective and safe in preventing intra-abdominal candidiasis in high-risk surgical patients, reducing Candida colonization; however, fluconazole remains the first choice in the preventive use of antifungals and one of the first agents for treatment of invasive candidiasis.

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