Introduction
============

Invasive candidemia is a major cause of increased mortality among ICU patients. Antifungal agents like liposomale amphotericin B and azoles could not accomplish the claim to be first choice in the treatment of invasive fungal infection (IFI) because of side effects and effectiveness. Especially, cardiothoracic surgery patients as a group of high-risk patients are in a focus for new strategies and agents. A new class of antimycotic agents, the echinocandins, with a low profile of side effects, low interactive potential and high effectiveness in the treatment of candidemia, is a powerful option in the treatment of IFI. We report our single-center experience with a modified clinical treatment approach based on clinical score of Leon and using echinocandins as first-line therapy for proven and suspected fungal infection.

Methods
=======

From May 2011 to October 2012, 2,844 patients were treated on our cardiothoracic ICU. We evaluated 37 cardiothoracic postoperative patients with proven or suspected IFI or prophylaxis (Figure [1](#F1){ref-type="fig"}). The records were evaluated for cardiothoracic procedures, microbiological and yeast date, cardiothoracic surgery score (CASUS), ICU and clinical data.

![**Cologne antifungal strategy**.](cc12023-1){#F1}

Results
=======

Mean age was 67.4 years with 64% male patients. Most patients had combined CABG and valve procedure (*n*= 20), other groups were HTX and LTX (*n*= 4), assist therapy (*n*= 4), TAVI (*n*= 3) and other procedures. Mean predicted mortality using the logarithmic CASUS score at the onset of IFI was 59%. *C. albicans*was isolated in 73%, *C. glabrata*in 21%. Length of antifungal treatment using micafungin in 30 cases was 14 ± 5 days. Eradication of yeast was successful in 79% but mortality of all patients remains high at 36.8% but was lower than predicted in the CASUS score. Mortality was not yeast related.

Conclusion
==========

Our described treatment approach shows encouraging results for the treatment of IFI especially in high-risk cardiothoracic patients.
