[Treatment approach for fungal infections in XXXX @entity1 admitted to intensive care units: results of a multicenter survey].

@entity1 @entity4658 @entity295 @entity2379 @entity2380 @entity3124 @entity4963 @entity6378 @entity7553 @entity6831 @entity166 @entity221 @entity298 @entity1049
INTRODUCTION: Two consensus conferences taking place in the United States and Spain were organized to optimize diagnosis and treatment of Candida spp. infections. Among other results, clinical scenarios in which early prescription of antifungal agents is indicated were identified. OBJECTIVE: To determine the criteria followed by physicians for prescribing antifungal agents in @entity3124 @entity1 in our country and to investigate adherence to the guidelines proposed by the consensus conferences. METHODS: A questionnaire was designed and directed to 4th- and 5th-year residents in intensive care medicine and to specialists in intensive care with training in @entity166 or other medical areas. Four case reports for which expert consensus indicates early antifungal treatment were included in the questionnaire; 1) recurrent @entity298 secondary to perforation of the digestive tract, with mixed flora including fungi; 2) persistent @entity221 in a @entity1 with @entity1049 treated with broad-spectrum antibiotics; 3) candiduria and @entity4658 in a febrile @entity1 ; and 4) @entity4963 . RESULTS: A total of 135 questionnaires from 45 different ICUs were returned (60% response rate). In the @entity4963 and @entity6378 examples, early treatment with antifungal agents was indicated in 100% and 85.9% of responses, respectively, whereas for @entity295 with @entity7553 and candiduria associated with @entity4658 and @entity221 , early treatment was prescribed in only 41.5% and 55.6% of responses, respectively. There were no significant differences in response with regard to degree of training of the physicians surveyed. @entity2380 prescription predominated, mainly at doses of 400 mg/day, in mixed @entity298 , @entity6831 , whereas @entity2379 lipid formulations were preferentially indicated in cases of @entity4963 . Antifungal treatment (early or late) was prescribed in all responses for @entity4963 , in 95.5% for mixed @entity298 (fungi and bacteria), in 79.5% for @entity7553 in @entity1 with persistent @entity295 , and in 77.9% for candiduria with @entity221 and @entity4658 . CONCLUSIONS: Adherence to recommendations from the consensus conferences was high among intensive medicine specialists, with no differences according to level of training in @entity166 .
