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Semin Respir Crit Care Med 2022; 43(01): 046-059
DOI: 10.1055/s-0041-1741009
Review Article

Diagnosis and Management of Invasive Candida Infections in Critically Ill Patients

Aline El Zakhem
1   Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
,
Rachid Istambouli
2   Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
,
Jean-Francois Jabbour
3   Department of Internal Medicine, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
,
Joya-Rita Hindy
4   Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
,
Amal Gharamti
5   Department of Internal Medicine, Yale School of Medicine, Waterbury Hospital, Waterbury, Connecticut
,
Souha S. Kanj
1   Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
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Abstract

Invasive candidiasis (IC) has become a serious problem in the intensive care unit patients with an attributable mortality rate that can reach up to 51%. Multiple global surveillance studies have shown an increasing incidence of candidemia. Despite their limited sensitivity (21–71%), cultures remain the gold standard for the diagnosis of IC associated with candidemia. Many adjunct laboratory tests exist to support or rule out the diagnosis, each with its indications and limitations, including procalcitonin, 1,3-β-D-glucan, mannan and anti-mannan antibodies, and Candida albicans germ tube antibody. In addition, polymerase chain reaction-based methods could expedite species identification in positive blood cultures, helping in guiding early empirical antifungal therapy. The management of IC in critically ill patients can be classified into prophylactic, preemptive, empiric, and directed/targeted therapy of a documented infection. There is no consensus concerning the benefit of prophylactic therapy in critically ill patients. While early initiation of appropriate therapy in confirmed IC is an important determinant of survival, the selection of candidates and drug of choice for empirical systemic antifungal therapy is more controversial. The choice of antifungal agents is determined by many factors, including the host, the site of infection, the species of the isolated Candida, and its susceptibility profile. Echinocandins are considered initial first-line therapy agents. Due to the conflicting results of the various studies on the benefit of preemptive therapy for critically ill patients and the lack of robust evidence, the Infectious Diseases Society of America (IDSA) omitted this category from its updated guidelines and the European Society of Intensive Care Medicine (ESICM) and the Critically Ill Patients Study Group of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) do not recommend it.

Keywords

invasive candidiasis - treatment - diagnostic criteria


Publication History

Article published online:
16 February 2022

© 2022. Thieme. All rights reserved.

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