A significant number non-neutropenic patients hospitalized in ICUs are at risk for acquiring invasive fungal infections. These patients are at risk for infections caused by both Aspergillus and Candida. Infections with molds or yeasts can cause severe life-threatening disease. Mortality rates for invasive fungal disease are high and sometimes even exceed 30%. On the other hand, those microorganisms can only be colonized on patients hospitalised in ICUs. However, early diagnosis of invasive fungal diseases remains a challenge as well as a question of who and when to treat. These issues are very poorly defined. Invasive Candida infections are the most common invasive fungal infections, accounting for 70-90% of all invasive mycoses. This disease is associated with high mortality, especially in ICUs. Recent IDSA guidelines suggest that “empirical antifungal therapy should be considered in critically ill patients with risk factors for invasive candidiasis and no other known cause of fever.” Risk factors for invasive candidiasis are very well defined, however they are so numerous that almost all patients in ICUs are at risk. In order to enable early and appropriate therapy some prediction rules have been developed that recognize the patients for which antifungal therapy can be justified. However, there exist certain concerns about these rules. One of the developed prediction tools is “Candida score”. It has been shown that “Candida score” has clinical relevance in patients with hospital acquired severe sepsis or septic shock, and that this score can differentiate patients who would benefit from the early introduction of antifungal therapy from those for whom invasive candidiasis is highly improbable. Invasive aspergillosis (IA) is also an emerging issue in ICUs due to advances in medical care. An emerging and understudied population at risk of IA represents critically ill patients admitted to the ICU. IA in ICU patients is associated with high mortality. Conclusively, several issues in regard to IA in non-neutropenic ICU patients have to be stressed: the importance of timely diagnosis, institution of appropriate treatment as well as consideration of Aspergillus as a potential cause of disease in this particular group of patients.
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