Ebook Textbook of respiratory and critical care infections (1/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Textbook of respiratory and critical care infections (1/E): Part 2
Ebook Textbook of respiratory and critical care infections (1/E): Part 2
CHAPTER 14Invasive Fungal Infections in Critically III PatientsStijn I Blot, Koenraad VandewoudeABSTRACTIn the past decades, a demographic shift in ho Ebook Textbook of respiratory and critical care infections (1/E): Part 2ospital and intensive care unit (ICU) populations have been taking place with a greater proportion of strongly debilitated patients who are at risk for secondary opportunistic infections such as invasive fungal disease. _ e utmost important fungal pathogens encountered in ICUs are invasive candidias Ebook Textbook of respiratory and critical care infections (1/E): Part 2is and invasive (pulmonary) aspergillosis, with the exception of candidemia, the diagnosis of invasive fungal infections IS problematic. “ is may leadEbook Textbook of respiratory and critical care infections (1/E): Part 2
to a postponed diagnosis and therefore, delayed initiation Of antifungal therapy. Despite the availability of potent antifungal agents, mortality assCHAPTER 14Invasive Fungal Infections in Critically III PatientsStijn I Blot, Koenraad VandewoudeABSTRACTIn the past decades, a demographic shift in ho Ebook Textbook of respiratory and critical care infections (1/E): Part 2althcare have led to an unwelcome increase in the number of life-threatening infections due to true pathogenic and opportunistic fungi. Invasive candidiasis and invasive aspergillosis are the 2 major manifestations of opportunistic invasive mycoses.1-2 _ ese infections are being seen in ever increas Ebook Textbook of respiratory and critical care infections (1/E): Part 2ing numbers, largely because of the increasing size of the population at risk, “is population includes recipients of hematopoietic stem cell transplanEbook Textbook of respiratory and critical care infections (1/E): Part 2
ts and solid organ transplants, patients with hematological malignancies, patients infected with human immunodc ciency virus (HIV) developing acquiredCHAPTER 14Invasive Fungal Infections in Critically III PatientsStijn I Blot, Koenraad VandewoudeABSTRACTIn the past decades, a demographic shift in ho Ebook Textbook of respiratory and critical care infections (1/E): Part 2e and lifethreatening diseases. speciZcally in intensive care units (let’s). burn patients, and premature neonates, has improved survival but has created a demographic shift tn hospital and ICƯ populations with more debilitated patients at risk for secondary invasive opportunisticinfections. _ ese e Ebook Textbook of respiratory and critical care infections (1/E): Part 2volutions in medical practice have led to changes in the epidemiology of fungal infections.“ e importance of fungi as pathogens in hospitalized patienEbook Textbook of respiratory and critical care infections (1/E): Part 2
ts, in general, and in ICT patients in particular, has increased substantially in the past 3 decades. In the National Nosocomial Infections SurveillanCHAPTER 14Invasive Fungal Infections in Critically III PatientsStijn I Blot, Koenraad VandewoudeABSTRACTIn the past decades, a demographic shift in ho Ebook Textbook of respiratory and critical care infections (1/E): Part 2caused by any infectious disease, those due to mycoses increased from the 10th most common in 1980 to the 7th most common in 1997? _ e increased incidence of fungal infections has coincided with a decreased mortality from bacterial infections. “ is is probably the result of better antibiotic therapy Ebook Textbook of respiratory and critical care infections (1/E): Part 2, leading to an increased survival of patients who are predisposed to fungal infections, as well as. inappropriate antibiotic therapy disrupting the nEbook Textbook of respiratory and critical care infections (1/E): Part 2
ormal microbial Zora on the skin and the mucosal surfaces, z e increase in incidence of candidiasis have been most marked during the 19S0s.-;-6 but raCHAPTER 14Invasive Fungal Infections in Critically III PatientsStijn I Blot, Koenraad VandewoudeABSTRACTIn the past decades, a demographic shift in ho Ebook Textbook of respiratory and critical care infections (1/E): Part 2s and wards. □ e NNIS data showed that between 1980 and 1989. the incidence of primary candidemia increased by 487% in large hospitals and by 219% in smaller hospitals.5 z e overall rate of nosocomial fungal infections increased almost 5-fold over the same period. Candida species may account for app Ebook Textbook of respiratory and critical care infections (1/E): Part 2roximately 8-15% of all nosocomial bloodstream infections albeit that some studies report a much lower incidence of candidemia.8* In the past decades,Ebook Textbook of respiratory and critical care infections (1/E): Part 2
it has been suggested that in ICUs the incidence of invasive aspergillosis, mainly pulmonary involvement, is on the rise.1011 However, diagnosis of iCHAPTER 14Invasive Fungal Infections in Critically III PatientsStijn I Blot, Koenraad VandewoudeABSTRACTIn the past decades, a demographic shift in ho Ebook Textbook of respiratory and critical care infections (1/E): Part 2of patients is most probably a major factor in ucncing t he occurrence rate of invasive fungal infections.A sobering observation in infectious disease medicine and critical care is that invasive fungal infections arc often not diagnosed or are diagnosed late in the course of the disease, because dia Ebook Textbook of respiratory and critical care infections (1/E): Part 2gnostic techniques are less than ideal.1-113 In a large autopsy study, only 22% of invasive fungal infections were suspected or documented antemortem.Ebook Textbook of respiratory and critical care infections (1/E): Part 2
14 Clinicians are often frustrated since the weakness of current clinical, radiological, and mycological diagnostic modalities are nonspeciZc and inseCHAPTER 14Invasive Fungal Infections in Critically III PatientsStijn I Blot, Koenraad VandewoudeABSTRACTIn the past decades, a demographic shift in ho Ebook Textbook of respiratory and critical care infections (1/E): Part 2ome in bacterial infections. In spite of the availability of effective azole and polyene anlifungals for more than 3 decades and more recently, the development of the new generation triazoles and the echinocandins. fungal infection continues to carry a grim prognosis and is associated with signiZcan Ebook Textbook of respiratory and critical care infections (1/E): Part 2t morbidity and mortality, thus, representing a growing health-economic burden for modern healthcare systems. A robust management strategy for prophylEbook Textbook of respiratory and critical care infections (1/E): Part 2
axis, diagnosis, and therapy of invasive fungal infections, continues to evade clinicians and mycological experts from developing new noninvasive toolCHAPTER 14Invasive Fungal Infections in Critically III PatientsStijn I Blot, Koenraad VandewoudeABSTRACTIn the past decades, a demographic shift in ho Ebook Textbook of respiratory and critical care infections (1/E): Part 2GICAL EVIDENCE AND TEMPORAL TRENDSAutopsy data on the incidence of invasive fungal infection provide incontrovertible evidence for the importance of invasive fungal disease in the general population as well as in hospitalized patients.In a single tertiary care center study, analyzing trends in the p Ebook Textbook of respiratory and critical care infections (1/E): Part 2ostmortem epidemiology of invasive fungal infection between 1978 and 1992. 278 invasive fungalinfections were fou nd in a series of 8.214 autopsies (3Ebook Textbook of respiratory and critical care infections (1/E): Part 2
.38%). Over 12 years, the prevalence of invasive fungal infection rose from 2.2% (1978-1982) and 3.2% (1983-1987) to 5.1% (1998-1992) (p < 0.001). z iCHAPTER 14Invasive Fungal Infections in Critically III PatientsStijn I Blot, Koenraad VandewoudeABSTRACTIn the past decades, a demographic shift in ho Ebook Textbook of respiratory and critical care infections (1/E): Part 2 a declining trend.14z e same temporal trend was found in a nationwide Japanese unselected autopsy study, encompassing patients from 1969 to 1994.15 _ e frequency of visceral mycoses among the annual total numberof autopsy cases increased noticeably from 1.60% in 1969 to a peak of 4.66% in 1990 and Ebook Textbook of respiratory and critical care infections (1/E): Part 23.17% in 1994. Among them, the incidences of candidiasis and aspergillosis increased the most. After 1990. however, the frequency of visceral mycosesEbook Textbook of respiratory and critical care infections (1/E): Part 2
gradually decreased. Until 1989. the predominant causative agent was Candida species, followed in order by Aspergillus species and Cryprarwtts speciesCHAPTER 14Invasive Fungal Infections in Critically III PatientsStijn I Blot, Koenraad VandewoudeABSTRACTIn the past decades, a demographic shift in ho Ebook Textbook of respiratory and critical care infections (1/E): Part 2rgillosis rate rose from 0.39% in 1969 to a peak of 1.55% in 1990 and maintained a constant level of about 1.3% after 1991, surpassing the rale of invasive candidiasis.Two German studies conZrm These Zndings. In a single center study in a general hospital, the incidence of systemic mycoses was found Ebook Textbook of respiratory and critical care infections (1/E): Part 2 to be 0.98% in 4.813 necropsies.16 Whereas candidiasis predominated from 1973 till 1991. a shift towards aspergillosis was noticed in the period of 1Ebook Textbook of respiratory and critical care infections (1/E): Part 2
992-2001. “ e invasive candidiasis rale was 0.56%. and the aspergillosis rale was 0.37%. An incidence Of 6.6% for invasive candidiasis and of 1.3% forCHAPTER 14Invasive Fungal Infections in Critically III PatientsStijn I Blot, Koenraad VandewoudeABSTRACTIn the past decades, a demographic shift in ho Ebook Textbook of respiratory and critical care infections (1/E): Part 2pergillosis is actually surpassing invasive candidiasis, as the most frequent fungal infection found at autopsy. However, one should consider that most cases clinically Classi ed as ’invasive candidiasis’ effectively are candidernia without tissue invasion. - is entity of deZnite fungal infection by Ebook Textbook of respiratory and critical care infections (1/E): Part 2 Candida species maybe underestimated in necropsy studies.18DIAGNOSIS OFINVASIVE FUNGAL INFECTIONWith the exception of cryplococcal meningitis and canEbook Textbook of respiratory and critical care infections (1/E): Part 2
didemia. the diagnosis of invasive fungal infection at an early stage remains diZcult. DeZnite or proven diagnosis still remains on positive histopathCHAPTER 14Invasive Fungal Infections in Critically III PatientsStijn I Blot, Koenraad VandewoudeABSTRACTIn the past decades, a demographic shift in ho Ebook Textbook of respiratory and critical care infections (1/E): Part 2, diagnosis IS often constructed onInvasive Fungal Infections in Critically III Patients215Textbook of Respiratory and Critical Care Infectionsclinical and radiological data, and an estimation of the probability of acquiring invasive fungal infection based on estimation of host risk factors and epid Ebook Textbook of respiratory and critical care infections (1/E): Part 2emiological data, z IS has led to the concepts of probable and possible fungal disease, which are far more frequent diagnostic categories than provenEbook Textbook of respiratory and critical care infections (1/E): Part 2
fungal disease; the latter often being a post-mortem diagnostic Znding.Historically, invasive fungal infection was Zrst recognized problematic in patiGọi ngay
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