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Colegio de Medicina Interna de México.

2007, Número 3

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Med Int Mex 2007; 23 (3)


Candidemia en pacientes críticamente enfermos sin neutropenia: lo que el internista debe saber

Camacho-Ortiz A, Rositas NFH, Ramos JJ

Idioma: Español
Referencias bibliográficas: 42
Paginas: 234-239
Archivo PDF: 175.41 Kb.


RESUMEN

La candidemia es una enfermedad con elevada prevalencia en los hospitales, principalmente en la unidad de cuidados intensivos, que resulta en elevada mortalidad. En el decenio de 1990 disminuyeron las infecciones nosocomiales ocasionadas por C. albicans, pero incrementaron los casos originados por C. glabrata. Estos casos se atribuyeron a la elevada prescripción de fluconazol e itraconazol, aprobados por la FDA, y a su relación con infecciones de especies no albicans. Los pacientes críticamente enfermos son más susceptibles de padecer candidemia e infecciones profundas por Candida. El diagnóstico requiere sospecha significativa y del análisis de los factores predisponentes, pues los ensayos de laboratorio no son muy específicos y los cultivos tienen poca sensibilidad. Es importante identificar las especies de Candida, ya que tienen diferentes mecanismos de resistencia. Se dispone de gran variedad de medicamentos antifúngicos para el tratamiento de la candidemia; entre éstos, la anfotericina B, fluconazol, caspofungina o combinaciones de anfotericina B y fluconazol se prescriben con mayor frecuencia. Algunos fármacos (posaconazol, ravuconazol, micafungina y anidulafungina) aún se investigan y se pronostican resultados prometedores.


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