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Published on: July 1, 2020
Invasive candidiasis in intensive care medicine: shaping the future of diagnosis and therapy
Ignacio Martin-Loeches1,2, Oliver A Cornely3,4,5,6, David W Denning7
1Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, Dublin, Ireland. drmartinloeches@gmail.com.
Background:
Invasive candidiasis (IC) remains one of the most challenging infections in critical care, contributing significantly to morbidity, prolonged organ support, and mortality among intensive care unit (ICU) patients. The clinical landscape of IC is evolving, with increasing recognition of Candida non-albicans species and other yeasts formerly classified as Candida spp., alongside emerging multidrug resistance and growing complexity in host immune profiles.
Objectives:
This contemporary, multidisciplinary narrative review-authored by intensivists, infectious diseases specialists, clinical microbiologists, and pharmacologists-aims to provide ICU clinicians with practical, up-to-date insights into the diagnosis and management of IC. To maintain clinical focus, the review excludes non-IC fungal infections and non-ICU patient populations.
Methods:
Relevant literature and expert consensus were critically reviewed to summarize current diagnostic and therapeutic approaches for IC in critically ill patients. Emphasis was placed on pragmatic clinical application, diagnostic limitations, antifungal stewardship, and personalized therapeutic decision-making.
Results:
Despite the availability of novel antifungal agents with improved pharmacokinetic properties, treatment success in IC depends equally on timely and accurate diagnosis and individualized, context-aware therapy. Blood cultures continue to demonstrate limited sensitivity (~40%). Non-culture assays, including β-D-glucan and molecular diagnostics, provide faster detection and high negative predictive value but suffer from low positive predictive value and inconsistent adoption in clinical practice. The absence of validated host-derived biomarkers further limits risk stratification, antifungal discontinuation decisions, and personalized care.
Conclusions:
Emerging antifungal agents, stewardship strategies, and multidisciplinary care models are essential to improve clinical outcomes and reduce antifungal resistance. This review underscores the need for integrated, team-based diagnostic and therapeutic approaches to close persistent gaps in IC management, ultimately promoting more effective, timely, and individualized care for critically ill patients with Candida spp.
Insights
Invasive candidiasis (IC) in ICUs is complex, with evolving species and resistance. Effective management requires timely diagnosis and individualized treatment, integrating novel antifungals and multidisciplinary care to improve outcomes.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Clinical Microbiology
Background:
- Invasive candidiasis (IC) is a significant challenge in intensive care units (ICUs), leading to increased morbidity, organ support needs, and mortality.
- The landscape of IC is changing, with a rise in non-albicans Candida species, multidrug resistance, and complex host immune responses.
Purpose of the Study:
- To provide ICU clinicians with practical, up-to-date insights into the diagnosis and management of IC.
- To focus on contemporary, multidisciplinary approaches for critically ill patients.
Main Methods:
- A narrative review of relevant literature and expert consensus.
- Emphasis on pragmatic clinical application, diagnostic limitations, antifungal stewardship, and personalized therapy.
Main Results:
- Timely diagnosis and individualized therapy are crucial for treatment success in IC.
- Current diagnostic methods have limitations: blood cultures have low sensitivity (~40%), and non-culture assays have variable positive predictive values.
- Lack of validated host biomarkers hinders risk stratification and personalized treatment decisions.
Conclusions:
- Novel antifungal agents, robust stewardship, and multidisciplinary care are vital for improving IC outcomes and combating resistance.
- Integrated, team-based diagnostic and therapeutic strategies are needed to address current management gaps.
- The goal is to achieve more effective, timely, and individualized care for critically ill patients with Candida infections.
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