Invasive candidiasis and the utility of antifungal susceptibility testing in the ICU

Invasive fungal infections are a major cause of health care-associated morbidity and mortality in the ICU. In particular, Candida spp. are among one of the leading causes of bloodstream infections and sepsis. Advances in antifungal therapy in the last decade have led to many more options in the treatment of fungal infections, yet increasing resistance and clinical failures are common, especially in the management of invasive candidiasis in the ICU. Prompt diagnosis of these infections and appropriate antifungal treatment are imperative for improving survival. Although reliable antifungal susceptibility testing is available to aid in the therapy of fungal infections, testing is not always recommended. This review addresses the epidemiology of Candida infections in the ICU, antifungal resistance, therapy, and the usefulness of antifungal susceptibility testing in the ICU setting.