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Invasive candidiasis: comparison of management choices by infectious disease and critical care specialists

Eggimann, Philippe ; Calandra, Thierry ; Fluckiger, Ursula ; Bille, Jacques ; Garbino, Jorge ; Glauser, Michel-Pierre ; Marchetti, Oscar ; Ruef, Christian ; Täuber, Martin ; Pittet, Didier

In: Intensive Care Medicine, 2005, vol. 31, no. 11, p. 1514-1521

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    Title
    • Invasive candidiasis: comparison of management choices by infectious disease and critical care specialists
    Author
    • Eggimann, Philippe. Infection Control Program, University of Geneva Hospitals, 24 Rue Micheli-du-Crest, 1211, Geneva 14, Switzerland
    • Calandra, Thierry. Infectious Diseases Service, Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
    • Fluckiger, Ursula. Division of Infectious Diseases, University Hospital, Basel, Switzerland
    • Bille, Jacques. Institute of Microbiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
    • Garbino, Jorge. Division of Infectious Diseases, Department of Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland
    • Glauser, Michel-Pierre. Infectious Diseases Service, Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
    • Marchetti, Oscar. Infectious Diseases Service, Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
    • Ruef, Christian. Division of Infection Control and Prevention, Universitätsspital, Zurich, Switzerland
    • Täuber, Martin. Institute for Infectious Diseases, University of Bern, Bern, Switzerland
    • Pittet, Didier. Infection Control Program, University of Geneva Hospitals, 24 Rue Micheli-du-Crest, 1211, Geneva 14, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:320751
    Summary
    Objective: To compare the management of invasive candidiasis between infectious disease and critical care specialists. Design and setting: Clinical case scenarios of invasive candidiasis were presented during interactive sessions at national specialty meetings. Participants responded to questions using an anonymous electronic voting system. Patients and participants: Sixty-five infectious disease and 51 critical care physicians in Switzerland. Results: Critical care specialists were more likely to ask advice from a colleague with expertise in the field of fungal infections to treat Candida glabrata (19.5% vs. 3.5%) and C. krusei (36.4% vs. 3.3%) candidemia. Most participants reported that they would change or remove a central venous catheter in the presence of candidemia, but 77.1% of critical care specialists would start concomitant antifungal treatment, compared to only 50% of infectious disease specialists. Similarly, more critical care specialists would start antifungal prophylaxis when Candida spp. are isolated from the peritonal fluid at time of surgery for peritonitis resulting from bowel perforation (22.2% vs. 7.2%). The two groups equally considered Candida spp. as pathogens in tertiary peritonitis, but critical care specialists would more frequently use amphotericin B than fluconazole, caspofungin, or voriconazole. In mechanically ventilated patients the isolation of 104 Candida spp. from a bronchoalveolar lavage was considered a colonizing organism by 94.9% of infectious disease, compared to 46.8% of critical care specialists, with a marked difference in the use of antifungal agents (5.1% vs. 51%). Conclusions: These data highlight differences between management approaches for candidiasis in two groups of specialists, particularly in the reported use of antifungals