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Associations antifongiques dans les candidoses et aspergilloses invasives Export

Reanimation, Vol. In Press, Uncorrected Proof

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antifongique aspergillus candida infection

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Resume Les candidoses et les aspergilloses invasives sont des complications infectieuses majeures en reanimation, facteur important d'augmentation de la duree de sejour, des couts et de la mortalite. Leur traitement de premiere ligne beneficie de recommandations therapeutiques recentes proposant le plus souvent une monotherapie antifongique. La severite de ces infections et l'existence de nombreux travaux experimentaux soulevent cependant la question de l'apport des bitherapies antifongiques, initialement ou non. De rares etudes cliniques suggerent aussi, malgre des limites methodologiques, un benefice des associations caspofungine plus polyene ou caspofungine plus azole dans l'aspergillose ou demontrent l'absence d'antagonisme de l'association fluconazole plus amphotericine B dans les candidemies. Des etudes randomisees sont necessaires pour demontrer le benefice de telles associations. Une etude evaluant l'association anidulafungine plus voriconazole dans la prise en charge des aspergilloses invasives devrait debuter prochainement.Summary Invasive aspergillosis and candidiasis are major complications in intensive care units, which increase length of stay, cost, and mortality. Recent guidelines mostly recommend single antifungal therapy. Their extreme severity arise the potential interest of antifungal combinations, with a tremendous amount of available works in the field. Rare preliminary studies have suggested that caspofungin plus polyene or caspofungin plus azole combinations might be beneficial in invasive aspergillosis, and that fluconazole plus amphotericin B in candidiasis is not antagonistic in vivo. A study assessing anidulafungin plus voriconazole combination during invasive aspergillosis should start soon.


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