Invasive Candidiasis: Turning Risk into a Practical Prevention Policy?

Abstract

For 3 decades, systemic antifungal use was virtually a 1-drug act—amphotericin B. Administration of antifungal agents to critically ill patients was dominated by fear of toxicity rather than knowledge of its efficacy. In the past decade, the availability of azole antifungal agents with enhanced pharmacokinetic and safety profiles completely revolutionized systemic antifungal use. If anything, their arrival caught clinicians unprepared, and guidelines for the optimal use of triazoles lagged behind common practice utilization. Use of azole drugs in the surgical intensive care unit (SICU) has become an established fact of life, with use unimpeded by the slow development or, in many areas, complete absence of useful data.