[Strategies for antifungal treatment failure in intensive care units]

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Mycology

Context:

• Increasing incidence of invasive fungal infections (IFIs) in intensive care units (ICUs).
• Escalating antifungal resistance observed in clinical settings.
• High primary therapy failure rates (70%) for IFIs, influenced by pathogens and host factors.

Purpose:

• To enhance awareness of antifungal therapy failure in IFIs.
• To delineate clinical scenarios associated with treatment failure.
• To propose a management algorithm for suspected primary antifungal treatment failure.

Summary:

• Epidemiologic data indicate a growing prevalence and resistance of IFIs in ICUs.
• Current primary antifungal treatments exhibit a high failure rate, necessitating further investigation.
• This review outlines clinical contexts of failure and suggests a structured approach to manage these challenging cases.

Impact:

• Improved clinical decision-making for antifungal therapy in critically ill patients.
• Potential reduction in morbidity and mortality associated with refractory IFIs.
• Highlights the urgent need for novel antifungal agents and resistance surveillance.