From 2012 ESCMID to global 2025 ECMM/ISHAM/ASM Candida guidelines: What are the key differences & practical...

Area of Science:

• Medical Mycology
• Infectious Diseases
• Clinical Guidelines

Background:

• Previous guidelines required consulting multiple documents for invasive candidiasis management.
• The 2012 guidelines lacked comprehensive coverage of emerging resistance and newer antifungal agents.

Purpose of the Study:

• To present a unified, comprehensive global guideline for the management of invasive candidiasis.
• To incorporate recent advances in antifungal therapy and address emerging challenges like resistance.

Main Methods:

• Development of evidence-graded recommendations using the GRADE system.
• Inclusion of sections on emerging pathogens, antifungal stewardship, and infection control.
• Consideration of public health and resource-limited settings.

Main Results:

• Echinocandins remain first-line; new agents (rezafungin, novel orals) offer personalized, susceptibility-guided therapy.
• Recommends earlier IV-to-oral step-down for stable non-neutropenic patients and emphasizes source control.
• Addresses emerging resistance (e.g., Candida auris, azole-resistant Candida parapsilosis) and tailored strategies.

Conclusions:

• The global Candida 2025 guideline provides a single-document resource for practitioners.
• It enhances management of invasive candidiasis through updated treatment options and a focus on resistance and epidemiology.
• The guideline promotes personalized therapy, antifungal stewardship, and infection control globally.