Immunité antifongique - epgonline.org

Keeping ahead of
Candida
Tuesday 19 March 2013
12:30–13:30

Disclaimer information
Please note: This meeting may include reference
to use of some products in unlicensed indications
Please refer to the manufacturer’s prescribing information

Chair’s welcome
George Dimopoulos
(Greece)
AI/12/0053/EUf Date of preparation March 2013

Faculty
• Chair:
George Dimopoulos
(Greece)
• Philippe Montravers
(France)
• Robert Masterton
(UK)

Agenda
Welcome
Getting treatment right from the start
Maintaining effective treatment
Q&A followed by closing summary
George Dimopoulos
(Greece)
Philippe Montravers
(France)
Robert Masterton
(UK)
George Dimopoulos
(Greece)

Meeting materials
• Meeting summary book
• Question cards
• Evaluation form

Discussion sessions
• This is an interactive meeting – questions are encouraged…
• Please use the question cards in the meeting books
• Please state clearly who your question is for
• Question cards will be collected by meeting staff

Anti-Infectives Knowledge Network
• More information on the topics covered in this symposium
can be found at www.aiknowledgenetwork.eu,
the Anti-Infectives Knowledge Network part of EPG Online
• Carrying news, downloadable resources, videos and expert
interviews, the site is of interest to all involved in the ID field

Mobile telephones and devices
• Please ensure that all mobile devices are turned to
silent in the auditorium

Introduction

Critically ill patient
Dimopoulos G et al J Crit Care 2013 (in press)
Suspected
Fungal infection
Proven Blood cultures (+)
Biopsy (+)
Targeted treatment according to
- Guidelines
- Local Epidemiology
Risk factors (+)
Clinical signs (-)
Biomarkers (-)
Mycology (-)
Risk factors (+)
Biomarkers (+)
Clinical signs (-)
Mycology (-)
Risk factors (+)
Clinical signs (+)
Biomarkers (-)
Mycology (-)
How to select the antifungal agent
Hemodynamically unstable patient
Prophylaxis
Fluconazole
Pre-emptive
Treatment
Empirical
treatment
NO
YES
Echinocandins
YES
Azole resistance
Recent exposure
Local epidemiology
Colonization
Echinocandins
Patient is stabilized
Consider step-down to
Voriconazole or Fluconazole
Alternative
L-AmphoB
Alternatives
-Echinocandins
-Voriconazole
-L-AmphoB
NO
FLUCONAZOLE

Discussion
Please hand completed
question cards to meeting staff

Chair’s summary
George Dimopoulos
(Greece)

Keeping ahead of Candida
• Candidaemia continues to be associated with high mortality
rates 1–3
• Delaying treatment increases mortality 4,5
– However, starting treatment based solely on risk factors is difficult, as
many are common to ICU patients 6
• Treatment optimisation can improve outcomes and resource
utilisation 7
– De-escalation appears to be a clinically and cost-effective approach to
improving outcomes in patients with candidaemia 8
1. Calandra T, Marchetti O. Clin Infect Dis 2004;39:S185–92; Andes DR, et al. Clin Infect Dis 2012;54:1110–22
3. Cornely OA, et al. Clin Microbiol Infect 2012;18(Suppl. 7):19–37; 4. Garey KW, et al. Clin Infect Dis 2006;43:25–31
5. Morrell M, et al. Antimicrob Agents Chemother 2005;49:3640–5; 6. Guery BP, et al. Intensive Care Med 2009;35:55–62
7. Masterton RG. Crit Care Clin 2011;27:149–62; 8. Masterton RG, et al. In press

Your feedback is important…
• Please complete the
evaluation form
• Hand forms to meeting
staff at the exit

MYCAMINE (micafungin)
ABBREVIATED PRESCRIBING INFORMATION
(Consult the summary of product characteristics for full prescribing and adverse event information)
Presentation: Powder for solution for infusion. Each vial contains 50mg or 100mg micafungin sodium. Reconstituted 50mg vial contains 10mg/ml; 100mg vial contains 20mg/ml
of micafungin sodium. Indications: In adults, adolescents and children including neonates: treatment of invasive candidiasis; prophylaxis of Candida infection in allogeneic
haematopoietic stem cell transplantation patients or those expected to have neutropenia (ANC

Keeping ahead of
Candida
Tuesday 19 March 2013
12:30–13:30