tailieunhanh - Báo cáo y học: " Empiric anti-Candida therapy for patients with sepsis in the ICU: how little is too little"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Empiric anti-Candida therapy for patients with sepsis in the ICU: how little is too little? | Available online http content 13 4 180 Commentary Empiric anti-Candida therapy for patients with sepsis in the ICU how little is too little Yoav Golan Division of Geographic Medicine and Infectious Diseases Tufts Medical Center 800 Washington Street Boston MA 02111 USA Corresponding author Yoav Golan ygolan@ Published 21 August 2009 This article is online at http content 13 4 180 2009 BioMed Central Ltd Critical Care 2009 13 180 doi cc7977 See related research by Zilberberg et al. http content 13 3 R94 Abstract Prior analyses suggest that empiric fluconazole for ICU patients with sepsis is cost-effective. Using updated estimates of efficacy and cost Zilberberg and colleagues compare the use of micafungin with that of fluconazole. The authors conclude that micafungin is an attractive alternative to fluconazole. This conclusion is driven by recent reduction in micafungin s cost and by better activity of micafungin against azole-resistant Candida species. Their results are limited by inflated estimates of efficacy life expectancy and risk of Candida sepsis. This commentary explores the rationale for early anti-Candida strategies in the ICU and highlights the contribution and limitations of the article by Zilberberg and colleagues. In their article in Critical Care Zilberberg and colleagues examine the cost-effectiveness of empiric anti-Candida treatment for ICU patients with sepsis 1 . Over the past decade Candida has emerged as an invasive pathogen in many ICUs 2-4 . The case-fatality rate for Candida blood-stream infections is substantially higher than that for bacterial bloodstream infections 5 . Exploring the reasons for such a trend Kumar and colleagues 6 compared a large number of severe sepsis episodes caused by bacteria or Candida. Despite their high severity of illness and in contrast to patients with bacterial sepsis most of those with Candida sepsis did not receive effective treatment within