Controversies in Candida management

Area of Science:

• Medical Mycology
• Infectious Diseases
• Clinical Microbiology

Background:

• Invasive candidiasis (IC) presents significant morbidity and mortality.
• Despite diagnostic and management advances, several controversies persist.
• Antifungal resistance necessitates optimized treatment strategies.

Purpose of the Study:

• To review and clarify controversies in invasive candidiasis diagnosis and management.
• To examine evidence supporting different treatment approaches for IC.
• To highlight the role of biomarkers and predictive models in early IC detection.

Main Methods:

• Literature review of studies addressing IC management controversies.
• Analysis of evidence regarding central line-associated candidaemia treatment.
• Evaluation of different antifungal treatment strategies (prophylactic, empirical, pre-emptive, directed).

Main Results:

• Early central line removal is favored for central line-associated candidaemia.
• Echinocandins or polyenes are preferred agents, with azoles considered for Candida parapsilosis.
• Empirical echinocandin use showed no worse outcomes for C. parapsilosis.
• Prophylaxis is standard for high-risk cancer patients but debated for VLBW infants and ICU patients.

Conclusions:

• Pre-emptive therapy using predictive models and biomarkers (e.g., β-d-glucan) offers a cost-effective approach.
• Optimizing clinical predictive models and biomarkers is crucial for early IC detection.
• Antifungal stewardship principles should guide treatment decisions.