Surgical critical care: Fungal infections in surgical patients

OBJECTIVE: To review the epidemiology, risk factors, diagnosis, treatment, and prevention of Candida infections in surgical intensive care unit patients. DESIGN: Selected review of the literature. SETTING: Critically ill patients either in an intensive care unit or having undergone a major surgical procedure. INTERVENTIONS: None. MAIN RESULTS: Candida infections are the third most common cause of bloodstream infection in the intensive care unit, with increasing numbers of infections due to nonalbicans species. The diagnosis of an invasive fungal infection is difficult, and the risk factors must be recognized and minimized. There is no general consensus about what signs, symptoms, and cultures define a fungal infection. A new 1,3 beta-glucan blood test may assist is the definition of invasive fungal infection. Treatment of fungal infections is now possible with a variety of antifungal agents, with different spectrums of activity, mechanisms of action, and adverse events. Prevention (prophylaxis) is a reasonable strategy in highly selected patients with a significant risk of fungal infection. CONCLUSION: New antifungal agents and diagnostic tests may improve the outcome of surgical intensive care unit patients with invasive fungal infections. However, agreement about definitions of fungal infection makes study and conclusions of prevention and treatment trials difficult to interpret.