Invasive XXXX : the challenge continues.

@entity1 @entity1331 @entity25928 @entity2379 @entity2380 @entity298 @entity3124 @entity6177 @entity7553 @entity5132 @entity5637 @entity364 @entity1398 @entity5626 @entity1213 @entity3 @entity375 @entity8201 @entity5638 @entity11794
Invasive @entity364 (IFIs) are being increasingly recognized as a major threat in @entity3124 adult and paediatric @entity1 . They can range widely in severity and can be life threatening in some @entity1 . Candida and Aspergillus species are the most common causes of IFIs, but other @entity375 and filamentous fungi are emerging pathogens. @entity5132 , the most significant pathogenic species, is seen in almost all of the 17% of @entity1 treated in the @entity1213 ( @entity1213 ) who develop IFIs, and is associated with significant morbidity and mortality. Non-albicans spp. are becoming more common, particularly in @entity1398 @entity1 and those on existing @entity5638 therapy. Early diagnosis is challenging due to delays in, and low sensitivity of, confirmatory blood cultures, and difficulty in discriminating colonization from @entity3 . Once diagnosed, early initiation of appropriate antifungal therapy is essential for reducing morbidity and mortality. @entity2379 deoxycholate and @entity8201 , once standard therapy, have been largely superseded in the @entity1213 by broad-spectrum azoles, liposomal @entity2379 and the newer @entity5637 agents with improved efficacy/tolerability profiles. The @entity5626 ( @entity11794 , @entity1331 and @entity25928 ) exhibit fungicidal activity against Candida spp. and fungistatic activity against Aspergillus spp. Echinocandins have demonstrated clinical efficacy, broad spectrum of activity and favourable pharmacological properties, and are, therefore, likely to replace @entity2380 as the initial antifungal agent of choice among @entity3124 @entity1 . Current evidence supports @entity5637 empirical therapy for candidaemia or @entity3 in @entity1213 @entity1 with or without @entity1398 , and as rescue therapy in @entity1 with life-threatening IFIs caused by strains resistant to other antifungals. Anidulafungin represents a new advance in the treatment of IFIs and is approved for treatment of candidaemia, @entity6177 , @entity298 and @entity7553 .
