Cristóbal León - Academia.edu (original) (raw)

Papers by Cristóbal León

Intensive Care Medicine, 2017

To describe concisely the current standards of care, major recent advances, common beliefs that h... more To describe concisely the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to Candida and Aspergillus infections in non-neutropenic patients in the ICU setting. Methods: A systematic review of the medical literature taking account of national and international guidelines and expert opinion. Results: Severe invasive fungal infections (IFIs) are becoming increasingly frequent in critically ill patients. Approximately 80% of IFIs are due to Candida spp. and 0.3-19% to Aspergillus spp. Recent observations emphasize the necessity of building a worldwide sentinel network to monitor the emergence of new fungal species and changes in susceptibility. Robust data on the attributable mortality are essential for the design of clinical studies with mortality endpoints. Although early antifungal therapy for Candida has been recommended in patients with risk factors, sepsis of unknown cause, and positive Candida serum biomarkers [β-1 → 3-d-glucan (BDG) and Candida albicans germ tube antibody (CAGTA)], its usefulness and influence on outcome need to be confirmed. Future studies may specifically address the optimal diagnostic and therapeutic strategies for patients with abdominal candidiasis. Better knowledge of the pharmacokinetics of antifungal molecules and tissue penetration is a key issue for intensivists. Regarding invasive aspergillosis, further investigation is needed to determine its incidence in the ICU, its relationship with influenza outbreaks, the clinical impact of rapid diagnosis, and the significance of combination treatment. Conclusions: Fundamental questions regarding IFI have to be addressed over the next decade. The clinical studies described in this research agenda should provide a template and set priorities for the clinical investigations that need to be performed.

Enfermedades Infecciosas y Microbiología Clínica, 2008

... Key words: Infections. ICU. Update. Correspondence: Dr. F. Álvarez-Lerma. Servicio de Medicin... more ... Key words: Infections. ICU. Update. Correspondence: Dr. F. Álvarez-Lerma. Servicio de Medicina Intensiva. Hospital del Mar. Pg. Marítim, 25-29. 08003 Barcelona. Spain. ... Staphylococcus aureus Huang SS, Yokoe DS, Hinrichsen VL, Spurchise LS, Datta R, Miroshnik I, et al. ...

Medical …, 2011

patients with hematological malignancies, and solid-organ transplant recipients [1]. Adequate emp... more patients with hematological malignancies, and solid-organ transplant recipients [1]. Adequate empirical antifungal therapy is received by only one quarter of patients with invasive Candida infections, despite the fact that inappropriate therapy is associated with increased mortality [8]. Predictive rules have been developed to select patients at high risk of candidiasis who may benefi t from prophylactic or pre-emptive/empirical antifungal therapy. The strategy of administering antifungal agents as pre-emptive or empirical therapy for C/IC (referred to here as early therapy) is currently unproven, but may signifi cantly improve outcomes and reduce hospital costs [9]. In this paper, we present an in-depth review of early therapy strategies to manage IC in adults, with an emphasis on the critically ill. Early treatment of candidemia in ICU patients The potential benefi t of early treatment of C/IC has been explored in a number of patient populations. Kumar and

Enfermedades Infecciosas y Microbiología Clínica, 2008

Enfermedades Infecciosas y Microbiología Clínica, 2011

Intensive Care Medicine, 2017

Enfermedades Infecciosas y Microbiología Clínica, 2008

Medical …, 2011

Enfermedades Infecciosas y Microbiología Clínica, 2008

Enfermedades Infecciosas y Microbiología Clínica, 2011