Vol.62 No.6 November 2014
Practice guidelines for dealing with candida infection in the fields of surgery, emergency and intensive care: "Antifungal Stewardship"
Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, 35 Shinanomachi, Tokyo, Japan
Abstract
In the fields of surgery, emergency and intensive care, patients with various severe underlying diseases often have severe infections with treatment-resistant bacteria, such as methicillin-resistant Staphylococcus aureus(MRSA) and multi-drug resistant Pseudomonas aeruginosa(MDRP). In such cases, fungal infections, especially candida infection, which occur during the process of treatment and are possibly attributable to antimicrobial use, emerge as a serious problem. In order to improve the outcomes of candida infection, it is important to consider targeted treatment for serious complications, such as for lesions of the eye, osteomyelitis, septic embolisms, and deep-seated abscesses, as well as to focus on extraction of high-risk patients based on the guidelines and early diagnosis and treatment. Although many guidelines recommend echinocandin drugs as the first-line antifungal drugs in these fields, it is necessary to implement a set of multidisciplinary practice guidelines, which we refer to as antifungal stewardship, in order to properly and effectively use antifungal drugs and succeed in antifungal therapy. For implementation of the guidelines, early-stage administration of antifungal drugs needs to be established in preemptive therapy or empiric treatment, the loading doses of antifungal drugs and the drug disposition need to be considered, and treatment based on antifungal heterogeneity, which uses the most suitable antifungal drug in terms of the drug properties and suppression of resistant strains, needs to be provided.
Key word
Candida albicans, non-albicans Candida, candidemia, antifungal stewardship, antifungal heterogeneity
Received
July 16, 2014
Accepted
August 19, 2014
Jpn. J. Chemother. 62 (6): 663-673, 2014
