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The article discusses a study that examined the role of central venous catheter (CVC) removal in the outcomes of Swiss adult patients with candidemia. Candida in the bloodstream can cause CVC infection, while the CVC can be a primary source of fungemia. The results indicate that failure to remove the CVC can be a consequence, rather than a cause, of death in patients with candidemia.

In the original publication the members of the FUNGINOS network were provided in such a way that they could not be indexed as collaborators on PubMed. [ABSTRACT FROM AUTHOR]

Thirty to forty percent of patients with recurrent gastrointestinal perforation/anastomotic leakage or acute necrotizing pancreatitis develop intra-abdominal invasive candidiasis (IC). A corrected Candida colonization index (CCI) ≥0.4 is a powerful predictor of IC. Fluconazole prevents intra-abdominal IC in this setting, but azole-resistant Candida species are emerging. The aim of this study was to explore the efficacy and safety of caspofungin for prevention of intra-abdominal IC in high-risk surgical patients. Prospective non-comparative single-center study in consecutive adult surgical patients with recurrent gastrointestinal perforation/anastomotic leakage or acute necrotizing pancreatitis. Preventive caspofungin therapy (70 mg, then 50 mg/day) was given until resolution of the surgical condition. Candida colonization index and CCI, occurrence of intra-abdominal IC and adverse events were monitored. Nineteen patients were studied: 16 (84%) had recurrent gastrointestinal perforation/anastomotic leakage and 3 (16%) acute necrotizing pancreatitis. The median duration of preventive caspofungin therapy was 16 days (range 4–46). The colonization index decreased significantly during study therapy, and the CCI remained <0.4 in all patients. Caspofungin was successful for prevention of intra-abdominal IC in 18/19 patients (95%, 1 breakthrough IC 5 days after inclusion). No drug-related adverse event requiring caspofungin discontinuation occurred. Caspofungin may be efficacious and safe for prevention of intra-abdominal candidiasis in high-risk surgical patients. This needs to be further investigated in randomized trials. [ABSTRACT FROM AUTHOR]

Objective: To compare the management of invasive candidiasis between infectious disease and critical care specialists.Design and Setting: Clinical case scenarios of invasive candidiasis were presented during interactive sessions at national specialty meetings. Participants responded to questions using an anonymous electronic voting system.Patients and Participants: Sixty-five infectious disease and 51 critical care physicians in Switzerland.Results: Critical care specialists were more likely to ask advice from a colleague with expertise in the field of fungal infections to treat Candida glabrata (19.5% vs. 3.5%) and C. krusei (36.4% vs. 3.3%) candidemia. Most participants reported that they would change or remove a central venous catheter in the presence of candidemia, but 77.1% of critical care specialists would start concomitant antifungal treatment, compared to only 50% of infectious disease specialists. Similarly, more critical care specialists would start antifungal prophylaxis when Candida spp. are isolated from the peritoneal fluid at time of surgery for peritonitis resulting from bowel perforation (22.2% vs. 7.2%). The two groups equally considered Candida spp. as pathogens in tertiary peritonitis, but critical care specialists would more frequently use amphotericin B than fluconazole, caspofungin, or voriconazole. In mechanically ventilated patients the isolation of 10(4) Candida spp. from a bronchoalveolar lavage was considered a colonizing organism by 94.9% of infectious disease, compared to 46.8% of critical care specialists, with a marked difference in the use of antifungal agents (5.1% vs. 51%).Conclusions: These data highlight differences between management approaches for candidiasis in two groups of specialists, particularly in the reported use of antifungals. [ABSTRACT FROM AUTHOR]

The authors reflect on the effect of using antifungal agents in treating invasive candidiasis (IC). It relates the paper published by Pérez-Para and collegues that challenge antifungal therapy. The study suggests that a central venous catheters (CVC) tip culture positive of Candida spp. should not be immediately considered as an IC and that the use of antifungal agents should be reduced. The study also suggests that ill patients with sepsis should not take antifungal therapy.

Presents the study of intravenous fluconazole prophylaxis in mechanically ventilated surgical and medical ICU patients. Role of Candida in nosocomial infections; Concomitant selective digestive decontamination in the patients; Selection of patients who might benefit from antifungal prophylaxis.

Presents a letter to the editor referencing articles and topics on disseminated histoplasmosis discussed in previous issues.

A correction to the article "Voriconazole-induced periostitis" that was published in the October 26, 2011 issue is presented.

Presents a response of a reader to a letter to the editor about his article "Prevention of Severe Candida Infections in Non-Neutropenic, High-Risk, Critically Ill Patients. " in the August 2003 issue of the periodical.