Systemic candidiasis in a surgical intensive care unit.

Treatment for systemic candidiasis has often been withheld because of the nephrotoxicity of standard amphotericin B therapy, particularly in immunodepressed patients. The authors describe their experience between 1981 and 1983 with 29 such patients in the intensive care unit who were treated with low-dose amphotericin B. The diagnosis was made when endophthalmitis or persistent fungemia was present, or when Candida was cultured from three or more body sites. The daily dose of amphotericin B was 0.3 to 0.5 mg/kg. Treatment was accompanied by a mean increase in the serum creatinine value of 26% in patients who did not undergo dialysis before therapy, but this did not lead to renal failure. The overall death rate was 72.4%. Non-survival appeared to be associated with an inadequate total dosage (less than 6 mg/kg); survivors received a mean total dose of 570 mg. A retrospective analysis of positive peritoneal cultures failed to support their previously reported significance. The authors conclude that, in some instances, low-dose amphotericin B will effectively treat systemic candidiasis, resulting in little renal impairment, and that the criteria for such treatment require re-evaluation.