ACTUALIZACION DEL MANEJO DE CANDIDASIS INVASIVA
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ACTUALIZACION DEL MANEJO DE CANDIDASIS INVASIVA

(especial para SIIC © Derechos reservados)
Actualización acerca de las diferentes formas de presentación de candidiasis invasiva y su tratamiento en pacientes críticos internados en unidades de cuidados intensivos.
blot9.jpg Autor:
Stijn Ivan Maria Blot
Columnista Experto de SIIC

Institución:
Ghent University Hospital


Artículos publicados por Stijn Ivan Maria Blot
Coautor
Koenraad Vandewoude* 
MD, PhD, Ghent University Hospital, Gante, Bélgica*
Recepción del artículo
28 de Agosto, 2006
Aprobación
1 de Septiembre, 2006
Primera edición
8 de Febrero, 2007
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Las especies de Candida son patógenos predominantes en pacientes críticamente enfermos. En las unidades de cuidados intensivos (UCI), la candidiasis invasiva se asocia con un pronóstico nefasto, pero un tratamiento adecuado puede limitar la mortalidad; sin embargo, esto se complica por las dificultades diagnósticas, ya que el cuadro clínico de la enfermedad invasiva no es específico y los hemocultivos tienen baja sensibilidad. Además, con frecuencia es difícil diferenciar la colonización de la enfermedad invasiva, y muchos pacientes críticamente enfermos están ampliamente colonizados por especies de Candida, en especial cuando reciben antibióticos de amplio espectro. El desarrollo de nuevos y prometedores agentes antifúngicos con perfiles de seguridad favorables, como los azoles y las equinocandinas, han abierto las puertas hacia la prevención y la optimización del tratamiento de la infección establecida. Gracias a estos nuevos agentes, se han han llevado adelante diversas estrategias terapéuticas para el manejo de la candidiasis invasiva: profilaxis, tratamiento preventivo, terapia antifúngica empírica y definitiva. Cada una de estas estrategias está dirigida a una población específica, definida por determinadas condiciones subyacentes, por factores de riesgo individuales o por ambos. El principal objetivo es lograr el equilibrio entre la prevención óptima y la administración oportuna del tratamiento, por una parte, y por la otra, minimizar la presión de selección a fin de evitar un cambio hacia especies de Candida menos susceptibles.

Palabras clave
candidiasis invasiva, pacientes críticamente enfermos, cuidados intensivos, terapia antifúngica, equinocandinas, azoles


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Abstract
Candida species are predominant pathogens in critically ill patients. In intensive care units, invasive candidiasis is associated with a grim prognosis but adequate therapy may limit the attributable mortality. Yet, adequate therapy is hindered by a problematic diagnosis as the clinical picture of invasive disease is non-specific and blood cultures have a low sensitivity. Furthermore, it is often difficult to differentiate colonization from invasive disease and many critically ill patients are extensively colonized with Candida species, especially when receiving broad-spectrum antibiotics. The development of new promising antifungal agents with a favorable safety profile such as azoles and echinocandins opened doors towards prevention and optimized therapy in case of definite infection. Through the arrival of these new agents, a range of therapeutic strategies for the management of invasive candidiasis has been developed: prophylaxis, preemptive therapy, empiric and definitive antifungal therapy. Each of these strategies has a specific target population, as defined on specific underlying conditions and/or individual risk factors. The principal goal is to balance between optimal prevention and timely administration of therapy on one hand, and minimizing selection pressure on the other hand in order to avoid a shift towards less susceptible Candida species.

Key words
echinocandins, azoles, invasive candidiasis, antifungal therapy, intensive care, critically ill patients


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Especialidades
Principal: Infectología
Relacionadas: Bioquímica, Cuidados Intensivos, Diagnóstico por Laboratorio, Farmacología, Medicina Farmacéutica, Medicina Interna



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Stijn Ivan Blot, Intensive Care Dept., Ghent University Hospital, 9000, De Pintelaan 185, Gante, Bélgica
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