الفهرس 
Fungal Infection in ICUOnly 14 pages are availabe for public view
Abstract
Summary
The incidence of nosocomial infection caused by fungi
had been increased steadily for the past 25 years. This
increased incidence of nosocomial infection may be related
to impairment of immune response as a result of a variety of
genetic disorders, malignancy, burn, organ transplantation,
endocrinal disorders, chemotherapy, immunosuppressive
drugs, and certain viral infection, notably human
immunodeficiency virus (HIV).
There have been changes in the epidemiology of fungal
infections in the last decade. Candida infections, a major
cause of death in patients with leukemia and
recipients of stem cell or solid organ transplants, are now
seen more often in patients in the intensive care unit (ICU).
Reports reveal that fungal infection was responsible for
9.65% of nosocomial blood-stream infections and 25% of
nosocomial urinary tract infections. Other reports revealed that
fungal infection was responsible for 7.9% of all nosocomial
infections.
The species of Candida causing infection are more
diverse: Candida albicans does not predominate as it once
did; Candida glabrata, an organism often resistant to
fluconazole, has become prevalent in some hospitals.
Changes in the epidemiology of mold infections have also
occurred and there has been an increase in infections due to
other molds, such as Scedosporium apiospermum, Fusarium
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species, and zygomycetes, such as Rhizopus and Mucor.
These molds are angioinvasive, infiltrating through blood
vessels and leading to extensive tissue infarction and
widespread dissemination. Many of the emerging molds are
resistant to amphotericin B.
Other minor pathogens include Fusarium species,
Cryptococcus neoformans, Pneumocystis carinii,
Mucormycosis, Phaeohyphomycosis, Trichosporon, and
Malassezi.
The concomitant use of culture and non-culture
techniques for the diagnosis and confirmation of systemic
mycotic infections is recommended. A diagnosis based on a
single specimen and method, especially when the results are
negative, is not always conclusive. The testing of multiple
or serial specimens increases the chances for establishing a
rapid and definitive diagnosis.
Direct methods include microscopic detection in wet
film or stained smear, and antigen detection. Direct methods
also include chemical detection (of specific metabolites or
certain fungal components) or detection through Polymerase
chain reaction. Indirect methods include detection of serum
antibodies against certain pathogen.
Paralleling these changes in the epidemiology of
fungal infections has been the introduction of new
antifungal agents. The expanded spectrum triazole
voriconazole has become the agent of choice for the
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treatment of invasive aspergillosis. It also has activity
against many of the molds that have emerged as pathogens
in recent years and is effective for Candida infections. The
broad spectrum of activity and the availability of both
intravenous and a well-absorbed oral formulation are
advantages of voriconazole; disadvantages are more drug–
drug interactions and side effects than noted with other
azoles. The echinocandins caspofungin and micafungin are
members of an entirely new class of antifungal agents that
are increasingly used for the treatment of Candida infections
and are effective agents for aspergillosis that has become
refractory to other therapy.
A major advantage of the echinocandins is that they
have very few side effects; the disadvantages are that they
are available only as intravenous formulations and the
spectrum of activity is relatively narrow. The new
antifungal agents have led to many fewer patients requiring
treatment with amphotericin B.
Prevention of nosocomial fungal infection include staff
education and infection surveillance, interrupting
transmission of potentially invasive fungal species (through
air filtration, directed room air-flow, well-sealed room,
room-air pressure, room-air changes), and modifying host
risk for infection.