Treatment of candidemia in adult patients without neutropenia - an inconvenient truth 英文参考文献.docVIP

Póvoa and Gon?alves-Pereira Critical Care 2011,15:114 /content/15/1/114 CO MMENTA RY Treatment of candidemia in adult patients without neutropenia - an inconvenient truth Pedro Póvoa* and Jo?o Gon?alves-Pereira A critical review of the evidence Abstract e 2009 IDSA guidelines [1] represent a marked change In 2009 the Infectious Diseases Society of America reviewed the guidelines on the treatment of candidemia in non-neutropenic patients. In this document the preferred treatment was either in the recommended therapeutic approach, and is not supported by the e? cacy of the di? erent antifungals. In all nine clinical trials, AmB-d and LF-AmB were never inferior to any comparator and two recent meta-analyses ?uconazole or an echinocandin. Amphotericin-B showed the same result e use of AmB-d and LF- formulations were considered an alternative. However, careful assessment of published data showed similar e?cacy between these drugs. AmB are supported by very solid data from well designed clinical trials and that have consequently been twice graded A-I [1]. Moreover, echinocandins are not suitable for the treatment of endophtalmitis, meningitis and endocarditis [5] whilst AmB remains the drug of choice. erefore, even though not explicit in the guidelines, the change is probably related to a possible advantage of Introduction Fungal infections, in particular candidemia, are a growing problem in immunocompetent patients [1]. Despite echinochandins and the perceived renal dysfunction several guidelines, concern exists on the value of evidence supporting recommendations for the optimal treatment of candidemia in non-neutropenic adult patients [1,2]. In the midst of this controversy a critical reappraisal of the 2009 Infectious Diseases Society of America (IDSA) associated with AmB. In fact, the 2009 IDSA guidelines [1] attribute to AmB-d therapy a high risk of acute renal failure (ARF) a