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Author Spotlight: Enhancing Candida albicans Detection in Catheter Infections Using Fluorescent Protein Tagging
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Invasive candidiasis in critical care: challenges and future directions.

C Logan1,2, I Martin-Loeches3,4, T Bicanic1,2

  • 1Institute of Infection and Immunity, St George's University of London, London, UK.

Intensive Care Medicine
|September 29, 2020
PubMed
Summary

Invasive candidiasis, a critical care fungal infection, faces challenges from drug-resistant Candida species and optimizing antifungal therapy. Addressing these is vital for improving patient outcomes in intensive care units (ICUs).

Keywords:
AntifungalBiomarkersCandidiasisCritical careFungal

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Area of Science:

  • Critical care medicine
  • Mycology
  • Infectious diseases

Background:

  • Invasive candidiasis is a prevalent and lethal fungal infection in critical care settings.
  • Risk factors include broad-spectrum antimicrobials, immunosuppression, and invasive procedures like ECMO.
  • Mortality rates for invasive candidiasis range from 40-55%.

Purpose of the Study:

  • To review key challenges in managing invasive candidiasis in the ICU.
  • To discuss the evolving epidemiology of Candida species and antifungal resistance.
  • To examine strategies for timely antifungal therapy initiation and discontinuation and appropriate drug selection.

Main Methods:

  • This is a review article, synthesizing current evidence and guidelines.
  • It focuses on three main challenges: epidemiological shifts, antifungal therapy timing, and drug selection.
  • Evidence on diagnostic tools and clinical prediction rules for antifungal stewardship is examined.

Main Results:

  • Global Candida epidemiology is shifting towards non-albicans species, including multi-resistant Candida glabrata and Candida auris.
  • Early antifungal strategies and diagnostic tools show promise but require careful implementation.
  • Tailored antifungal selection is crucial for complex ICU patients with comorbidities or on ECMO.

Conclusions:

  • Managing invasive candidiasis requires addressing antifungal resistance and optimizing therapy.
  • Improved diagnostic tools and clinical prediction rules can guide antifungal stewardship.
  • Future research should prioritize tailored treatment approaches for critically ill patients.