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Title: Candidemia and invasive candidiasis approach in critically ill patients: role of the echinocandins
Authors: Almirante, Benito
Garnacho-Montero, Jose
Maseda, Emilio
Javier Candel, Francisco
Grau, Santiago
Guinea, Jesus
Moreno, Ignacio
Munoz, Patricia
Ruiz Santana, Sergio 
UNESCO Clasification: 320806 Quimioterapia
Keywords: Continuous Venovenous Hemofiltration
Liver-Transplant Recipients
Severe Abdominal Conditions
Escmid-Asterisk Guideline
Renal Replacement Therapy, et al
Issue Date: 2017
Journal: Revista Espanola de Quimioterapia 
Abstract: Introduction. Invasive infections caused by Candida spp. in critically ill patients may significantly worsen their prognosis, so it is of great importance to establish an early detection and a suitable therapeutic strategy. The objective of this study was to define the differential role of echinocandins in treating certain critical patient profiles.Methodology. A scientific committee of 9 experts in infectious diseases, critical care, microbiology, and hospital pharmacy reviewed the existing evidence on the treatment of candidemia and invasive candidiasis in critically ill patients. After that, a questionnaire with 35 items was elaborated to be agreed by 26 specialists in the aforementioned disciplines using a modified Delphi method.Results. After two rounds of evaluation, a consensus was reached in terms of agreement in 66% of the items. Some of the consensuses achieved included: it is not necessary to adjust the dose of echinocandins during renal replacement therapy; the echinocandins are the empirical and/or directed treatment of choice for candidemia and invasive candidiasis associated with biofilms; these drugs may be used in the antifungal prophylaxis of high-risk liver transplantation. In the absence of additional clinical data, it should be noted that micafungin is the echinocandin with the most available scientific evidence.Conclusions. The experts consulted showed a high degree of agreement on some of the most controversial aspects regarding the management of candidemia and invasive candidiasis in critical patients, which could inform of practical recommendations for their treatment.
ISSN: 0214-3429
Source: Revista Espanola De Quimioterapia [ISSN 0214-3429], v. 30 (5), p. 355-367, (Octubre 2017)
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