Management of invasive candidiasis in the ICU: Challenges and advances (Review).

Abstract

Invasive candidiasis (IC) is one of the principal causes of morbidity and mortality in critically ill patients, particularly in intensive care units (ICUs). Early diagnosis and prompt treatment are vital for achieving optimal outcomes for patients; however, factors such as delayed diagnosis, antifungal resistance and difficulty in managing critically ill patients make this difficult. The present review describes some of the major challenges involved in the management of IC in ICU settings, including delays in diagnosis, outbreaks of multi-drug-resistant Candida species and high mortality rates. Improvements in innovative diagnostic methods, including rapid molecular testing, as well as developments in antifungal therapy, such as rezafungin and ibrexafungerp, help improve patient outcomes. In addition, antifungal stewardship, prevention and combination therapy enhance the management of this complex infection. The present review also discusses clinical guidelines emphasizing the need for early empirical therapy, species-specific definitive treatment, and proper treatment duration. Continuous research toward new diagnostic procedures, antifungal agents and vaccines is essential to overcoming the challenges posed by IC in critically ill patients.