[Role and importance of fungal infections in intensive care units].

INTRODUCTION

The incidence of fungal infections is constantly increasing, especially in Intensive Care Units (ICU). On the one hand ICU are places for treatment of most difficult, often immunodeficient patients, and on the other hand their treatment often requires invasive procedures, support of vital organs and adequate monitoring.

EPIDEMIOLOGY

In approximately 78% of patients the cause of infection are Candida species with mortality rate of 57%. Less common causative agents are Aspergillus species, but with very high mortality rate of up to 100%.

PATHOGENESIS

Candida albicans is a normal inhabitant of the oropharygeal and digestive systems. Hospitalization, trauma, loss of immunity and use of strong antibiotics facilitate fungal colonization. Inadequate nutrition, poor perfusion, ischemia and corticosteroid therapy lead to damage of intestinal mucosa. Combined with improper production of IG A, it predisposes to translocation of fungi through mucosa and invasion of the blood stream.

CLINICAL MANIFESTATIONS

Most common forms are urinary tract infections, intrabdominal candidiasis, disseminated candidiasis and candidemia.

DIAGNOSIS

Diagnosis of fungal infections is very difficult. It is based on clinical picture, microbiological, histological, radiological, serologic and molecular examinations.

TREATMENT

Treatment is usually based on systemic antimycotic agents (Amphotericin B, Azoles: Fluconazole, Flucytosine). Prophylactic treatment is still a matter of debate. It is not routinely recommended in ICU, but is commonly used in transplant patients.