Review
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World J Crit Care Med. Nov 4, 2014; 3(4): 102-112
Published online Nov 4, 2014. doi: 10.5492/wjccm.v3.i4.102
Invasive candidiasis in critical care setting, updated recommendations from “Invasive Fungal Infections-Clinical Forum”, Iran
Ashraf Elhoufi, Arezoo Ahmadi, Amir Mohammad Hashem Asnaashari, Mohammad Ali Davarpanah, Behrooz Farzanegan Bidgoli, Omid Moradi Moghaddam, Mohammad Torabi-Nami, Saeed Abbasi, Malak El-Sobky, Ali Ghaziani, Mohammad Hossein Jarrahzadeh, Reza Shahrami, Farzad Shirazian, Farhad Soltani, Homeira Yazdinejad, Farid Zand
Ashraf Elhoufi, Department of Critical Care Medicine, Dubai Hospital, Dubai Health Authority, Dubai 7272, United Arab Emirates
Arezoo Ahmadi, Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran 1136746911, Iran
Amir Mohammad Hashem Asnaashari, Department of Pulmonology and Critical Care, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad 45191735, Iran
Mohammad Ali Davarpanah, Department of Infectious Diseases and Tropical Medicine, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
Behrooz Farzanegan Bidgoli, Tracheal Disease Research Center, Shahid Behesti University of Medical Sciences, Tehran 1956944413, Iran
Omid Moradi Moghaddam, Department of Anesthesiology and Critical Care, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran 145151366, Iran
Mohammad Torabi-Nami, Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
Mohammad Torabi-Nami, Behphar Scientific Committee, Behphar Group, Tehran 1991915613 Iran
Saeed Abbasi, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan 7346181746, Iran
Malak El-Sobky, Invasive Fungal Infections-Clinical Forum, Dubai 9662 United Arab Emirates
Ali Ghaziani, Intensive Care and Burn Units, Motahhari Hospital, Tehran 1996714353, Iran
Mohammad Hossein Jarrahzadeh, Reza Shahrami, Invasive Fungal Infections-Clinical Forum, Tehran 1991915613 Iran
Farzad Shirazian, Intensive Care Unit, Vali-e-Asr Hospital, NAJA University, Tehran 19967, Iran
Farhad Soltani, Department of Anesthesiology and Critical Care, Golestan Hospital, Ahwaz Jundishapur University of Medical Sciences, Ahwaz 6135715794, Iran
Homeira Yazdinejad, Department of Anesthesiology and Critical Care, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran
Farid Zand, Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
Author contributions: Elhoufi A moderated the clinical forum and contributed to literature review; other than the first author, at second order, Ahmadi A, Asnaashari AMH, Davarpanah MA, Farzanegan Bidgoli B, Moradi Moghaddam O and Torabi-Nami M equally contributed to literature review and plenary talks as well as summary of recommendations (sorted alphabetically as second-order authors); at third order, Abbasi S, El-Sobky M, Ghaziani A, Jarrahzadeh MH, Shahrami R, Shirazian F, Soltani F, Yazdinejad H and Zand F equally contributed to this consensus through inputs and critical reversion of the manuscript for important intellectual content (sorted alphabetically as third-order authors); Torabi-Nami M drafted the manuscript; Torabi-Nami M and El-Sobky M provided technical material support; all authors read and approved the final manuscript.
Correspondence to: Mohammad Torabi-Nami, MD, PhD, Assistant Professor of Neuroscience, Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Zand St., Shiraz 7134814336, Iran. torabinami@sums.ac.ir
Telephone: +98-713-2317523 Fax: +98-713-2318042
Received: August 31, 2014
Revised: September 24, 2014
Accepted: October 23, 2014
Published online: November 4, 2014
Abstract

Invasive candidiasis (IC) bears a high risk of morbidity and mortality in the intensive care units (ICU). With the current advances in critical care and the use of wide-spectrum antibiotics, invasive fungal infections (IFIs) and IC in particular, have turned into a growing concern in the ICU. Further to blood cultures, some auxiliary laboratory tests and biomarkers are developed to enable an earlier detection of infection, however these test are neither consistently available nor validated in our setting. On the other hand, patients’ clinical status and local epidemiology data may justify the empiric antifungal approach using the proper antifungal option. The clinical approach to the management of IC in febrile, non-neutropenic critically ill patients has been defined in available international guidelines; nevertheless such recommendations need to be customized when applied to our local practice. Over the past three years, Iranian experts from intensive care and infectious diseases disciplines have tried to draw a consensus on the management of IFI with a particular focus on IC in the ICU. The established IFI-clinical forum (IFI-CF), comprising the scientific leaders in the field, has recently come up with and updated recommendation on the same (June 2014). The purpose of this review is to put together literature insights and Iranian experts’ opinion at the IFI-CF, to propose an updated practical overview on recommended approaches for the management of IC in the ICU.

Keywords: Invasive candidiasis, Intensive care unit, IFI-clinical forum, Recommendations, Iran

Core tip: The present consensus statement has attempted to summarize the practical highlights regarding the management of Invasive Candidiasis (IC) in critical care setting. This easy-to-follow clinical pathway is expected to be not only of interest but also of clinical use for those who deal with the management of invasive fungal infections in hospital setting and especially the intensive care units. The focus of this paper is the concept of timely management of IC in critically ill patients.