Current opinion in critical care
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This review covers candidaemia in numbers, susceptibility issues, host groups, risk factors and outcome. ⋯ The changing epidemiology highlights the need for close monitoring of local incidence, species distribution and susceptibility in order to optimize therapy and outcome.
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Curr Opin Crit Care · Oct 2010
ReviewEvolving use of biomarkers for kidney injury in acute care settings.
Acute kidney injury is increasingly recognized in acute care settings in more recent years. Proper diagnosis and risk stratification for acute kidney injury is necessary for carrying out appropriate and cost-effective treatments in patients with acute kidney injury. Kidney markers serve as diagnostic and prognostic tools to give physicians a more complete perspective of renal insult. The aim of this review is to highlight some of the evidence from recent studies, involving kidney markers and provide current opinion on the accuracy of these markers. ⋯ Each individual kidney marker possesses its own strengths and weaknesses in determining the onset and severity of acute kidney injury. However, in combination, a panel of kidney markers may serve as powerful tools in diagnosing kidney injury with high accuracy.
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Curr Opin Crit Care · Oct 2010
ReviewProphylaxis, empirical and preemptive treatment of invasive candidiasis.
Invasive candidiasis remains an important infection for ICU patients, associated with poor clinical outcomes. It has been increasingly recognized that the traditional paradigm of culture-directed antifungal treatment is unsatisfactory, and that earlier antifungal intervention strategies, such as prophylaxis, preemptive therapy, and empiric therapy, are required to improve patient outcomes. The purpose of this review is to summarize the recent supportive evidence for such strategies and to highlight the current challenges in their implementation. ⋯ On the basis of current knowledge, it is difficult to universally recommend antifungal prophylaxis, apart from patient groups with a known very high risk, such as those with necrotising pancreatitis or recurrent gastrointestinal perforations. Antifungal prophylaxis may also be reasonable where local incidence rates and epidemiology are compelling. Among stable patients with multifocal Candida colonization and/or a multitude of clinical-risk factors, preemptive therapy is currently not indicated, although the development of better risk predictive models may assist with such patients. Among patients with refractory fever despite broad-spectrum antibacterial therapy, empiric antifungal therapy may be reasonable where local incidence rates are high (e.g. >10%); however, a thorough search for alternate causes must be instituted.
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The intensive care unit (ICU) provides continuous surveillance and specialized care to acutely ill patients. The decisions on patient admission and discharge should be based on common clinical criteria in order to guarantee equity. ⋯ The decisions to admit and discharge patients depend on patient, structure and physician-related variables. Early ICU admission of the critically ill patient is beneficial. Future analysis should also investigate economic parameters.