Current opinion in infectious diseases
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Invasive fungal infections remain a serious complication for critically ill ICU patients. The aim of this article is to review recent efficacy data of newer antifungal agents for the treatment of invasive candidiasis. The influence that recent epidemiological trends, advances in diagnostic testing, and risk prediction methods exert on the optimization of antifungal therapy for critically ill ICU patients will also be reviewed. ⋯ Echinocandins, given their clinical efficacy, spectrum of activity, and favourable pharmacological properties, are likely to replace fluconazole as initial antifungal agents of choice among critically ill ICU patients. The optimization of patient outcomes will require more accurately targeted early antifungal intervention strategies based upon sensitive and specific biological and clinical markers of risk.
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Curr. Opin. Infect. Dis. · Dec 2008
ReviewGram-negative sepsis in the intensive care unit: avoiding therapeutic failure.
The purpose of this review is to examine some of the latest concepts in the management of sepsis and septic shock in the Intensive Care environment, with a focus on Gram-negative infections. ⋯ The balance between the most effective and the most responsible prescribing is difficult to strike, but recognition of the impact of antibiotic failure makes it even more important to consider how we husband the microflora of the ICU. New therapeutic options are somewhat limited but goal-directed protocol-driven approaches linked with sound knowledge of the microflora and our impact upon it as an ecosystem is essential.