Management of invasive candidiasis in French ICUs: insights from a 2024 nationwide survey.

Abstract

Purpose: Invasive candidiasis (IC) is a major challenge in intensive care units (ICUs) given its high prevalence, mortality rate, and diagnostic complexity. This national survey aimed to evaluate the knowledge of French intensive care specialists, assess the available resources for IC management, and analyze current bedside practices in ICUs.

Methods: A cross-sectional survey was conducted among senior ICU physicians from 221 French ICUs. A structured questionnaire addressing organizational, diagnostic, and therapeutic approaches to IC management, including clinical cases, was distributed, achieving a participation rate of 54.7%.

Results: Of the 121 respondents, 75 provided complete data. Most respondents were experienced intensivists working in public centers and managing hematological oncology patients. Although 65 (74%) respondents reported organizing multidisciplinary staff meeting, mycologists were rarely involved. Despite the availability of rapid diagnostic tools such as serum (1,3)-β-D-glucan (BDG), which was accessible to 63 (75%) respondents, integrating them into patient management at the bedside remains challenging. Additionally, 55 (67%) respondents had access to antifungal therapeutic drug monitoring (TDM), with voriconazole being the most frequently monitored antifungal drug. However, only 5 (9.1%) respondents had access to TDM every day of the week.

Conclusion: This survey highlights the strengths of multidisciplinary teams, TDM and rapid diagnostic tools for managing IC. However, significant gaps remain in their practical application, particularly the integration of diagnostic tools into clinical algorithms to guide bedside decision-making. Optimizing antifungal stewardship through coordinated interventions is essential for accelerating the diagnosis of IC, improving clinical outcomes, reducing resistance and adverse events.