Increasing
numbers of critically ill patients develop fungal or yeast infections,
which are associated with high mortality. Now a review published
in the online open access journal, Critical Care, compares treatments
involving single-drug antifungal prophylaxis (SAP) or a multi-drug
regimen of selective digestive tract decontamination (SDD) and suggests
that both methods reduce yeast-related morbidity and mortality,
but to different extents.
A team
from Academic Medical Center Amsterdam, the Netherlands set out
to compare the effectiveness of preventative antifungal therapies
by trawling the medical databases. This yielded data from more than
5,500 patients enrolled in over thirty studies. The team compared
data on SAP and SDD treatments in critically ill patients, detailing
the incidence of yeast colonisation, infection, candidemia, and
hospital mortality.
Both
SDD and SAP reduced yeast-associated disease among the critically
ill. The authors findings suggest that SDD is more effective
than SAP for reducing yeast colonisation and infection, with the
exception of candidemia. The latter responded best to SAP. Although
both strategies decreased mortality attributable to yeast, SDD led
to a significant reduction in all-cause in-hospital mortality.
Systemic
drugs may be advised as prophylaxis in patients with a high risk
of developing Candida bloodstream infections, whereas SDD may be
given to critically ill patients to prevent Candida colonisation
and infection, the authors suggest.
Effective
management of yeast infections is tricky, because diagnostic blood
tests are only around 70 percent accurate, and it is hard to differentiate
between normal yeast colonies and infection. Previous studies have
investigated both SAP and SDD, but to date there has been no direct
comparison between the two treatments. In 1995, yeast was reported
to be the fourth most common intensive care unit-acquired infection
in Europe. It could now be even more common, in lack of more recent
data. Candida is also the fourth leading cause of all nosocomial
blood stream infections in the USA, accounting for up to 11% of
all infections.
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