Table Of ContentFungal Infection in the
Intensive Care Unit
PERSPECTIVES ON CRITICAL CARE
INFECTIOUS DISEASES
Jordi Rello, MD., Series Editor
1. N. Singh and J.M. Aguado (eds.): Infectious Complications in
Transplant Recipients. 2000. ISBN 0-7923-7972-1
2. P.Q. Eichaclcer and 1. Pugin (eds.): Evolving Concepts in Sepsis
and Septic Shock. 2001. ISBN 0-7923-7235-2
3. J. Rello and K. Leeper (eds.): Severe Community Acquired
Pneumonia. 2001. ISBN 0-7923-7338-3
4. R.G. Wunderink and 1. Rello (eds.): Ventilator Associated
Pneumonia. 2001. ISBN 0-7923-7444-4
5. R.A. Weinstein and M. Bonten (eds.): Infection Control in the ICU
Environment. 2002. ISBN 0-7923-7415-0
6. R.A. Barnes and D.W. Warnock (eds.): Fungal Infection in the
Intensive Care Unit. 2002. ISBN 1-4020-7049-7
Fungal Infection in the
Intensive Care Unit
edited by
R.A. BARNES
University ofWales College ofMedicine, Cardiff,
United Kingdom
D.W. WA RNOCK
Centers for Disease Control and Prevention, Atlanta,
Georgia, USA
ISBN 978-1-4613-5333-1 ISBN 978-1-4615-0977-6 (eBook)
DOI 10.1007/978-1-4615-0977-6
A C.I.P. Catalogue record for this book is available
from the Library of Congress.
Copyright © 2002 by Springer Science+Business Media New York
Originally published by Kluwer Academic Publishers in 2002
Softcover reprint ofthe hardcover Ist edition 2002
All rights reserved. No part ofthis work may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means, electronic, mechanical,
photocopying, microfilming, recording, or otherwise, without the written
permission from the Publisher, with the exception of any material supplied
specifically for the purpose of being entered and executed on a computer system,
for exclusive use by the purchaser of the work.
Pennission for books published in Europe:
Contents
Contributors VII
Preface ix
Epidemiology ofCandida Infections in the Intensive Care Unit 1
North American Perspective
RANA A. HAJJEH AND G. MARSHALL LYON
Cross-Infection with Candida in the Intensive Care Unit 13
European Perspective
JACQUES BILLE
Risk Factors for Candida Infection in the Intensive Care Unit 23
North American Perspective
RHONDA V. FLEMING AND THOMAS J . WALSH
Risk Factors for Candida Infections in the Intensive Care Unit 45
European Perspective
ROSEMARY A. BARNES
Laboratory Diagnosis of Fungal Infection in the Intensive Care Unit 55
North American Perspective
CHRISTINE J. MORRISON
VI
Clinical Diagnosis of Fungal Infection in the Intensive Care Unit 105
European Perspective
PAULG. FLANAGAN
Management ofCandida Infections in the Intensive Care Unit 129
North American Perspective
JOHN E. EDWARDS, JR.
Management ofCandida Infections in the Intensive Care Unit 139
European Perspective
NEIL SONI
Non-Candida Fungal Infections in the Intensive Care Unit 165
North American Perspective
MARCOS I. RESTREPO AND JOHN R. GRAYBILL
Non-Candida Fungal Infections in the Intensive Care Unit 181
European Perspective
HILARY HUMPHREYS
Index 191
Contributors
Rosemary A. Barnes, MA, MSc, MD, MRCP, FRCPath,
Senior Lecturer, Department of Medical Microbiology, University of
Wales College of Medicine, and Honorary Consultant, University
Hospital ofWales, Cardiff, UK.
Jacques Bille, MD,
Professor and Head, Clinical Bacteriology Laboratory, Institut de
Microbiologie, Centre Hospitalier Universitaire Vaudois, Lausanne,
Switzerland.
John E. Edwards, Jr., MD,
Professor of Medicine, University of California Los Angeles School of
Medicine, and Chief, Division of Infectious Diseases, Research and
Education Institute, Harbor/UCLA Medical Center, Los Angeles,
California, USA.
Paul G. Flanagan, MB ChB, MD, MRCPath,
Senior Lecturer, Department of Medical Microbiology, University of
Wales College of Medicine, and Honorary Consultant, University
Hospital ofWales, Cardiff, UK.
Rhonda V. Fleming, MD,
Fellow in Infectious Diseases, Hospital of Saint Raphael, Yale University
School ofMedicine, New Haven, Connecticut, USA.
VIII
John R. Graybill, MD,
Professor ofMedicine, University of Texas Health Science Center at San
Antonio, and Division of Infectious Diseases, Audie L. Murphy Veterans
Affairs Medical Center, San Antonio, Texas, USA.
Rana A. Ha.ijeh, MD,
Chief, Epidemiology Unit, Mycotic Diseases Branch, Division of
Bacterial and Mycotic Diseases, National Center for Infectious Diseases,
Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Hilary Humphreys, MD, FRCPI, FRCPath,
Professor, Department of Clinical Microbiology, Royal College of
Surgeons in Ireland, and Beaumont Hospital, Dublin, Ireland.
G. Marshall Lyon, MD,
Fellow in Infectious Diseases, Department of Medicine, Massachusetts
General Hospital, Boston, Massachusetts, USA.
Christine J. Morrison, PhD,
Chief, Diagnostics Development Unit, Mycotic Diseases Branch,
Division of Bacterial and Mycotic Diseases,. National Center for
Infectious Diseases, Centers for Disease Control and Prevention, Atlanta,
Georgia, USA.
Marcos I. Restrepo, MD,
Fellow in Infectious Diseases, Department of Medicine, University of
Texas Health Science Center, San Antonio, Texas, USA.
Neil Soni, MB ChB, MD, FRCA, FFICANZCA, FANZCA,
Consultant in Intensive Care, Chelsea and Westminster Hospital,
London, United Kingdom.
Thomas J. Walsh, MD, FACP, FCCP,
Chief, Immunocompromised Host Section, Pediatric Oncology Branch,
National Cancer Institute, Bethesda, Maryland, USA.
Preface
Fungal infections are an increasing problem in critically-ill patients and
these infections carry an attributable mortality that is much higher than
corresponding bacterial infections. In both Europe and North America,
Candida infections predominate and much of this book concentrates on the
epidemiology, risk factors, diagnosis and treatment of these infections.
Particular reference is made to the cross-infection problems of Candida
infection and the importance of infection control and preventative measures.
However, other fungal infections are increasingly being seen in critically-ill
patients.
Advances in the management of severely immunocompromised patients
have resulted in their improved survival. Increasingly, transplant recipients,
persons with AIDS, and patients with severe neutropenia require intensive
care and the range of opportunist fungal pathogens in this group is wide. In
addition, in many parts of North America, infections with endemic fungi,
such as Histoplasma capsulatum and Blastomyces dermatitidis, may be
encountered among patients in intensive care. A description of these
infections is included.
Establishing a robust diagnostic strategy in fungal infection is a problem
that continues to evade clinicians. The list of available antifungal agents,
whilst growing, is more limited than the antibacterial repertoire.
Consequently, a variety of strategies for the recognition and treatment of
fungal infection in critical care are employed. The evidence base for these
strategies is discussed.
This book is designed to offer a European and North American
perspective on each topic. There are many similarities in experience and
clinical practice but also significant differences that we hope will stimulate
further thought and study. We hope the book will be of interest to
x
intensivists, infectious disease specialists, medical microbiologists and all
those with an involvement in critical care. Progress in intensive care
medicine is resulting in a growing population of critically-ill patients at risk
of fungal infection. Further improvements in survival will require a
multidisciplinary approach.
ROSEMARY A. BARNES
University ofWales College ofMedicine, Cardiff, United Kingdom
DAVID W. WARNOCK
Centers for Disease Control and Prevention, Atlanta, Georgia. USA
