INVASIVE FUNGAL Infections

VOLUME 1 NUMBER 2 2007 The Journal of INVASIVE FUNGAL infections EDITOR-IN-CHIEF John R Perfect, Durham, NC, USA Clinical Trials of Antifungal Prophylaxis in Surgical Critically Ill Patients Ed Horn, Sandra M Swoboda, and Pamela A Lipsett Preemptive Antifungal Therapy in Critically Ill Surgical Patients Frédéric Grenouillet, Laurence Millon, Gilles Blasco, and Renaud Piarroux Diagnostic and Therapeutic Approaches to Fungal Infections in Critical Care Settings: Different Options but the Same Strategy Rafael Zaragoza and Javier Pemán www.invasivefungalinfections.com Jointly sponsored by the University of Kentucky Colleges of Pharmacy and Medicine and Remedica. The University of Kentucky is an equal opportunity university. This journal is supported by an educational grant from Schering-Plough The Journal of Invasive Fungal Infections is supported by an educational grant from Schering-Plough Corporation Editor-in-Chief Editor John Perfect Zeina A Kanafani Division of Infectious Diseases Director, Research Fellow, Division of Infectious Diseases, Mycology Research Unit, Duke University Duke University Medical Center, Durham, NC, USA Medical Center, Durham, NC, USA Editorial Advisory Board David Andes Graeme Forrest Assistant Professor, Departments of Medicine Director of Antimicrobial Program at University and Medical Microbiology & Immunology, of Maryland and Assistant Director of Infectious University of Wisconsin, Madison, WI, USA Diseases in the Greenebaum Cancer Center Division of Infectious Diseases, University of Maryland Oliver Cornely School of Medicine, Baltimore, MD, USA Assistant Professor of Medicine, Klinik I für Innere Medizin, Klinikum der Universität Köln, Köln, Raoul Herbrecht Germany Professor of Hematology, Department of Hematology and Oncology, Ben de Pauw Hôpital de Hautepierre, Strasbourg, France Professor of Medicine, Department of Blood Transfusion Service and Transplant Immunology, Dimitrios P Kontoyiannis University Medical Center St Radboud, Director of Mycology Research Program, Nijmegen, The Netherlands The University of Texas, MD Anderson Cancer Center, Houston, TX, USA Francoise Dromer Head of the Molecular Mycology Unit and Nina Singh Director to the National Reference Center for Associate Professor of Medicine at University Mycoses & Antifungals, National Reference of Pittsburgh and Chief of Transplant Infectious Center for Mycoses & Antfungals, Institut Diseases, Infectious Diseases Section, Pasteur, Paris, France VA Medical Center, Pittsburgh, PA, USA Jay Fishman Andrew Ullmann Associate Professor of Medicine, Harvard Infectious Disease Consultant, Klinikum Johannes Medical School and Associate Director of MGH Gutenberg-Universität, Mainz, Germany Transplantation Center, Director of Transplant Infectious Disease and Compromised Host Program, Jo-Anne van Burik Infectious Disease Division, Massachusetts General Associate Professor, Department of Medicine, Hospital, Boston, MA, USA University of Minnesota, Minneapolis, MN, USA Foreword Dear Colleagues, Contents Welcome to the second issue of the CME/CPE-accredited journal, Leading Articles The Journal of Invasive Fungal Infections. Clinical Trials of Antifungal Prophylaxis As in the first issue, this issue contains review articles from leading specialists in the field. These have been peer-reviewed for quality and in Surgical Critically Ill Patients CME/CPE-accredited to provide an ongoing educational resource. Ed Horn, Sandra M Swoboda, and Pamela A Lipsett 34 Three such leading articles are included, and all discuss antifungal therapeutic strategies in critically ill patients. Preemptive Antifungal Therapy Professor Pamela Lipsett and colleagues (Johns Hopkins University in Critically Ill Surgical Patients School of Medicine and Nursing, Baltimore, MD, USA) provide an Frédéric Grenouillet, Laurence Millon, excellent overview of all clinical trials conducted to date on antifungal Gilles Blasco, and Renaud Piarroux 42 prophylaxis in surgical critically ill patients. They also discuss meta- analyses of clinical trials of antifungal prophylaxis, and discuss some of the concerns surrounding this therapeutic strategy in patients in Diagnostic and Therapeutic Approaches intensive care. Comprehensive tables summarizing the clinical trials and to Fungal Infections in Critical Care Settings: meta-analyses are included. Different Options but the Same Strategy Following this, Dr Frédéric Grenouillet and colleagues (University Rafael Zaragoza and Javier Pemán 50 Hospital, Besançon, France) review preemptive antifungal therapy, again in surgical critically ill patients. Firstly, they discuss the issues Clinical Reviews regarding the definition of “preemptive” therapy, and the use of Candida colonization status of the patient in this classification. Aspergillosis 59 Focusing on invasive candidiasis, they discuss its pathophysiology and Coccidioidomycosis 61 risk factors, and consider studies that have aimed to define criteria that predict which patients are at high risk of infection. Lastly, they discuss a Candidiasis 63 management flowchart for fungal infection risk, in use at their unit Cryptococcosis 65 since 2004. The third and final leading article of this issue, from Drs Rafael Other Mycoses 66 Zaragoza and Javier Pemán (Hospital Universitario Peset and Hospital Therapeutics 67 Universitario La Fe, Valencia, Spain), addresses the diagnostic and therapeutic approaches to fungal infections in critically ill patients. Meeting Report Preemptive and prophylactic therapeutic strategies are reviewed. In addition, newer diagnostic tests, such as the detection of (1,3)-β-D- The American Society of Hematology glucan, which may guide the therapeutic strategy in critically ill patients 48th Annual Meeting and Exposition are discussed. The choice of antifungal agent and the potential for Orlando, FL, USA, December 9–12, 2006 69 combination therapy in these patients are also reviewed. As in the first issue, Dr Zeina Kanafani (Duke University Medical Center, Durham, NC, USA) has provided a thorough analysis of recent papers in our Clinical Reviews section. This is followed by a report from the 48th Annual Meeting and Exposition of the American Society of Hematology from Dr Ana Berceanu and Professor Raoul Herbrecht (Hôpitaux Universitaires de Strasbourg, Strasbourg, France), in which the presentations describing invasive fungal infections, primarily aspergillosis, in patients with hematological malignancies or hematopoietic stem cell transplantation are reviewed. We hope you find this issue of The Journal of Invasive Fungal Infections an educational and valuable tool. We welcome your feedback regarding the material presented as well as your suggestions for future topics to be covered. John R Perfect Editor-in-Chief Editorial Policy Publisher’s Statement The Journal of Invasive Fungal Infections is an independent journal published by Remedica ©2007 Remedica Medical Education and Publishing. All rights reserved. No part of this Medical Education and Publishing. Editorial control is the sole responsibility of the Editor-in-Chief, publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any Editorial Advisory Board, and the Editors. Before publication, all material submitted to the journal means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission is subjected to rigorous review by the Editor-in-Chief, Editorial Advisory Board, Editors, and/or of the copyright owners. While every effort is made by the publishers and editorial board to see independent reviewers for suitability of scientific content, scientific accuracy, scientific quality, and that no inaccurate or misleading data, opinions, or statements appear in this journal, they wish to conflict of interest. make it clear that the material contained in the publication represents a summary of the Aims and Scope independent evaluations and opinions of the authors and contributors. As a consequence, the The Journal of Invasive Fungal Infections is designed to bring a critical analysis of the world fungal board, publishers, and any supporting company accept no responsibility for the consequences of infection literature, written by clinicians, for clinicians, to an international, multidisciplinary audience. any such inaccurate or misleading data or statements. Neither do they endorse the content of the Our mission is to promote better understanding of fungal infections across the global healthcare publication or the use of any drug or device in a way that lies outside its current licensed system by providing an active forum for the discussion of clinical and healthcare policy issues. application in any territory. Leading Articles – These major review articles are chosen to reflect topical clinical and healthcare Editorial Team: Rhian Phillips, Scott Millar, Samantha K Bell Editorial Director: Reghu Venkatesan policy issues in invasive fungal infections. All contributions undergo a strict editorial review process. Design and artwork: AS&K Skylight Creative Services Publishers: Ian Ackland-Snow, Simon Kirsch Clinical Reviews – The most important papers from the best of the international literature on fungal The Journal of Invasive Fungal Infections (ISSN 1753-3783) is published four times a year. infections are systematically selected by the Editor-in-Chief. The Editors then prepare concise and Additional subscription information is available from the publishers: Remedica Medical Education critical analyses of each paper, and, most importantly,

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