Treatment of invasive candidiasis in the elderly: a review

Figures & data

Table 1 Normal physiological alterations in the elderly

1. Diminished immunological response expressed by decreased phagocytosis

– Lack of antigen presenting cells (dendritic, naïve T-cells)

– Decreased memory capacity of mature T-cells

– Decreased cytokine production

– Decreased number of B-cells and immunoglobulin production

2. Decreased hepatic function due to decreased liver mass and blood flow, declining phase I metabolism, and decreased bile secretion

3. Decreased renal function (glomerular filtration rate declines on average 1% per year)

4. Hyposalivation

5. Candida colonization of dental prostheses

6. Candida colonization of the urinary tract, especially after broad spectrum antibiotic use

Note: Data from.^43,46–48

Table 2 Physiological effects of aging and their impact on drug metabolism

Hepatic function	Renal function	Body composition	Comorbidities	Alterations in receptor sensitivity
↓ Liver mass	↓ GFR	↓ Total body water	Heart failure	↓ β-receptor
↓ Hepatic blood flow		↑ Body fat	Hypertension	↓ CYP450
↓ Phase I metabolism (oxidation by CYP450 enzymes), further inhibited by Fluconazole			Diabetes Cancer Pain due to various diseases
↓ Bile secretion
Unaffected phase II metabolism

Abbreviations: GFR, glomerular filtration rate; ↓, decrease; ↑, increase.

Note: Data from.^43,48

Figure 1 Algorithm for the management of candidiasis in the elderly patient.

Note: *Although there are recent data suggesting that success rates of treating C. parapsilosis were similar for the echinocandin group versus other antifungal treatment groups.⁸¹ Adapted from Journal of Critical Care, Dimopoulos G, Antonopoulou A, Armaganidis A, Vincent JL. How to select an antifungal agent in critically-ill patients. In press. Copyright 2013, with permission from Elsevier.⁶²

Table 3 Risk factors for fungal infections in the elderly

• Multifocal (including oropharyngeal) colonization

• Presence of intravascular catheters (biofilm formation)

• Residence in health care facilities

• Admission and prolonged intensive care unit stay

• Renal failure

• Systemic administration of broad spectrum antibiotics

• Parenteral nutrition

• Recent abdominal surgery

• Neutropenia

• Use of corticosteroids or immunosuppressant drugs

Note: Data from.^{2,6,25,35,88–91}

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