Annals of Intensive Care最新文献

{"title":"Early de-escalation of antifungal treatment in critically ill immunocompromised patients with proven or probable invasive candidiasis: A retrospective multicentre study.","authors":"Karim Jaffal, Constance Bayon, Louis Kreitmann, Anahita Rouzé, Marie Labruyere, Annabelle Stoclin, Jean Reignier, Guillaume Brunin, Anais Dartevel, Boualem Sendid, Julien Labreuche, Saad Nseir","doi":"10.1016/j.aicoj.2026.100139","DOIUrl":"10.1016/j.aicoj.2026.100139","url":null,"abstract":"<p><strong>Background and objectives: </strong>Antifungal treatment (AFT) for proven or probable invasive candidiasis (IC) is common in critically ill immunocompromised patients. Early AFT de-escalation appears safe in unselected ICU patients, but has not been studied specifically amongst immunocompromised hosts.</p><p><strong>Methods: </strong>This retrospective study was conducted in 19 ICUs in France between January 2019 and December 2024. All immunocompromised patients hospitalized in ICU for ≥5 days and treated with antifungals for a first proven or probable episode of IC were included. Early AFT de-escalation was defined as either spectrum reduction, i.e., a switch from an initial echinocandin or liposomal amphotericin B to fluconazole, or complete discontinuation of the initial antifungal, occurring within 5 days (day 1-5) of treatment initiation. The primary objective was to determine the incidence of early AFT de-escalation (censored at day 28 after initiation of AFT).</p><p><strong>Results: </strong>242 patients were analysed (median age 64 years, 64% males). Most patients (<i>n=</i>175, 72.3%) were treated empirically or pre-emptively for probable IC. Early AFT de-escalation occurred in 92 patients (38%, 95% confidence interval [CI] 31.9%-44.2%). AFT de-escalation consisted of spectrum reduction in 35.9%, and AFT discontinuation in 64.1% of cases. There was no difference in ICU mortality, ICU length-of-stay and the number of ventilator-free days between patients with and without AFT de-escalation. AFT was re-initiated within 7 days of de-escalation in 6 of the 92 patients (6.5%) who had undergone early AFT de-escalation.</p><p><strong>Conclusions: </strong>Early AFT de-escalation occurred in 38% of critically ill immunocompromised patients, and was not associated with adverse prognostic outcomes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100139"},"PeriodicalIF":6.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional and muscle recovery after critical illness: current and future nutritional, physical and metabolic strategies.","authors":"Alexandre Pierre, Steve Lancel, Josepha Bertrac, Claire Bourel, Thierry Van Der Linden, Raphael Favory, Sebastien Preau","doi":"10.1016/j.aicoj.2026.100137","DOIUrl":"10.1016/j.aicoj.2026.100137","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Despite gains in survival, recovery from the physical consequences of critical illness has not improved. ICU-acquired weakness (ICUAW) develops in roughly half of mechanically ventilated patients and causes durable muscle dysfunction, reduced exercise capacity and curtailed autonomy that persist for years, with impact on quality of life and healthcare utilization. The diagnostic framework remains limited: the Medical Research Council sum score is informative at ICU discharge but loses sensitivity during convalescence, and capturing the full deficit requires multidimensional assessment of muscle function, physical function and quality of life, in line with the PRACTICE core outcome set and the conceptual continuum from acute ICUAW to post-ICU sarcopenia. Two pillars structure current therapy - nutritional support and physical rehabilitation. Nutritional support: avoidance of severe hyperglycaemia is established, but large RCTs consistently show that escalating acute-phase calorie or protein delivery does not improve, and may worsen, outcomes, particularly in vulnerable subgroups such as those with acute kidney injury. This paradox is explained by the concept of feeding responsiveness: anabolic resistance blunts muscle protein synthesis in a way that cannot be overcome by dose escalation; as inflammation and metabolism recover, a catabolic-to-anabolic transition restores nutrient utilization, and dynamic biomarkers (urea trajectory, phosphate kinetics, insulin resistance index) may identify the catabolic-to-anabolic transition at the bedside. These insights translate into a four-phase individualized strategy spanning permissive underfeeding with conditional escalation, standard targets, protocol-guided individualized support during early (in-hospital) convalescence, and enriched nutrition with structured dietitian-led follow-up after discharge. Physical rehabilitation: early mobilization improves short-term outcomes - muscle strength at ICU discharge, duration of mechanical ventilation and length of stay - but recent trials, notably TEAM, show that augmented-dose mobilization does not translate into long-term functional benefit and may harm identifiable subgroups, mirroring the nutritional paradox. The concept of exercise responsiveness - captured by clinical signatures of non-response (diabetes, low achievable ICU Mobility Scale, illness severity) and molecular determinants (persistent inflammation, mitochondrial and proteostatic dysfunction) - supports a four-phase physiology-informed prescription, from safety-first early mobilization to home-based adapted physical activity sustaining a continuous training stimulus. Beyond these two pillars, emerging metabolic support offers complementary, biology-targeted interventions still under preclinical and translational development. These include alternative oxidative substrates, autophagy and mitochondrial modulators, and anabolic agents - forcing anabolism acutely may be harmful, as growth hormone","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100137"},"PeriodicalIF":6.9,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual scoring of photoplethysmography morphology for risk stratification in hemorrhagic shock: a prospective observational study.","authors":"Peng Deng, Xuanyi Xiang, Yanyan Yu, Haifang Yu, Kelin Jia, Yu Cao","doi":"10.1016/j.aicoj.2026.100138","DOIUrl":"10.1016/j.aicoj.2026.100138","url":null,"abstract":"<p><strong>Purpose: </strong>Early recognition of high-risk patients with hemorrhage remains challenging, as conventional indicators may lack sensitivity during the compensated phase of blood loss. The study evaluated whether visual scoring of photoplethysmography (PPG) morphology could support bedside risk stratification during acute hemorrhage.</p><p><strong>Methods: </strong>In this prospective observational study conducted in the emergency department of West China Hospital between August and October 2025, 500 adults with hemorrhage were enrolled, of whom 461 were included in the final analysis. Three trained physicians independently scored PPG morphology using an ordinal 0-100 visual scale in 10-point increments. The final score was determined through majority voting. The primary outcome was 28-day all-cause mortality, while the secondary outcome was intensive care unit (ICU) admission. Moreover, lactate-related risk stratification was explored separately.</p><p><strong>Results: </strong>Inter-rater agreement was good to excellent based on pairwise linear weighted kappa (0.74, 0.99, and 0.75), whereas overall agreement was moderate based on Fleiss' kappa (0.58). The visual PPG score demonstrated good discrimination for both 28-day mortality (area under the curve [AUC] 0.81) and ICU admission (AUC 0.88), with numerically superior performance to the shock index, mean arterial pressure, lactate, and base excess. Adding the visual PPG score to routine clinical indicators increased the AUC for ICU admission from 0.82 to 0.90.</p><p><strong>Conclusion: </strong>Visual PPG scoring may support early bedside risk stratification in hemorrhagic patients and warrants external validation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100138"},"PeriodicalIF":6.9,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation of perfusion index to evaluate fluid responsiveness during the preload challenge tests: a systematic review and meta-analysis.","authors":"Haijun Huang, Linqing Liu, Tongfei Feng, Qinkang Shen, Hua Xu, Jiannong Wu","doi":"10.1016/j.aicoj.2026.100136","DOIUrl":"10.1016/j.aicoj.2026.100136","url":null,"abstract":"<p><strong>Background: </strong>The ability of perfusion index (PI) for predicting fluid responsiveness has been extensively studied with conflicting results. This meta-analysis evaluated the value of variation of PI (ΔPI) for predicting fluid responsiveness in adult patients undergoing preload challenge tests.</p><p><strong>Methods: </strong>PubMed, Embase, and Cochrane Library were searched up to 20th July 2026. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary receiver operator characteristic curve (AUROC) were calculated. <i>Q</i> test and <i>I²</i> statistics were used for study heterogeneity and publication bias was assessed by Deeks' funnel plot asymmetry test. Subgroup analysis was performed for the potential causes of heterogeneity arising from varied patient characteristics.</p><p><strong>Results: </strong>Overall, nine studies including 492 preload challenge tests were administered to 419 patients in this review, of whom 52% were fluid responsive. The cutoff values of ΔPI were increased between 1.024% and 33% or decreased between -7% and -40%. Pooled sensitivity and specificity were 0.79 (95% CI: 0.71-0.85) and 0.82 (95% CI: 0.75-0.87), respectively. DOR was 17 (95% CI: 10-30) and AUROC was 0.88 (95% CI: 0.85-0.90), indicating good diagnostic accuracy. Heterogeneity was low (<i>I</i> ² = 28.95%, <i>P</i> = 0.124). Subgroup analysis showed that ΔPI performed consistently across ICU and operating room settings, regardless of preload challenge type, PI device, or ventilation status.</p><p><strong>Conclusions: </strong>Our meta-analysis suggests that ΔPI may serve as a promising adjunct non-invasive marker for predicting fluid responsiveness during preload challenge tests, but the current evidence base remains limited, heterogeneous, and at risk of bias.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100136"},"PeriodicalIF":6.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-ICU length of stay in very old patients: interpreting prognosis within the ICU admission pathway.","authors":"Xiang Zhou, Zhengdong Hua","doi":"10.1016/j.aicoj.2026.100134","DOIUrl":"10.1016/j.aicoj.2026.100134","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100134"},"PeriodicalIF":6.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genomic and integrative based progression biomarker discovery in adult sepsis: toward clinical stratification and precision medicine.","authors":"Silvia Gonzalez-Barbuzano, Eva Suarez-Pajes, Miguel Bardají-Carrillo, Eduardo Tamayo, Tamara Hernandez-Beeftink, Carlos Flores","doi":"10.1016/j.aicoj.2026.100133","DOIUrl":"10.1016/j.aicoj.2026.100133","url":null,"abstract":"<p><p>Sepsis is a life-threatening syndrome characterized by a heterogeneous host response to infection that remains a major cause of mortality worldwide. Current clinical scoring systems capture organ dysfunction but fail to reflect the underlying biological diversity, limiting their utility for patient stratification and targeted therapy. This review provides a comprehensive overview of molecular biomarker approaches used to predict sepsis course and prognosis in adult patients, covering genetic, transcriptomic, proteomic, and integrative strategies up to May 2026. Here, we summarize findings from genetic association studies, along with analyses based on polygenic risk scores to aggregate genetic effects, Mendelian randomization, and rare-variant sequencing approaches. We also review transcriptomic and proteomic strategies for endotyping, and diagnostic and prognostic discrimination. Lastly, we discuss how multi-omics integration is emerging as a promising framework to assist in distinguishing causal therapeutic targets from non-causal biomarkers. We also address the challenges that still constrain clinical translation towards precision medicine.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100133"},"PeriodicalIF":6.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' reply to: Pre-ICU length of stay in very old patients: interpreting prognosis within the ICU admission pathway.","authors":"Björn Ahlström, Miklos Lipcsey","doi":"10.1016/j.aicoj.2026.100135","DOIUrl":"10.1016/j.aicoj.2026.100135","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100135"},"PeriodicalIF":6.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prebiotics, probiotics, and synbiotics therapy in critically ill patients: a systematic review and network meta-analysis.","authors":"Junji Hatakeyama, Ryo Yamamoto, Minoru Yoshida, Kohei Yamada, Kazushige Inoue, Takayuki Irahara, Satomi Ichimaru, Nobuto Nakanishi, Naoki Higashibeppu, Kensuke Nakamura, Joji Kotani","doi":"10.1016/j.aicoj.2026.100130","DOIUrl":"10.1016/j.aicoj.2026.100130","url":null,"abstract":"<p><strong>Background: </strong>Critically ill patients frequently develop intestinal dysbiosis, leading to gastrointestinal (GI) symptoms and infectious complications. No network meta-analysis (NMA) has compared the relative effectiveness of prebiotics, probiotics, and synbiotics for reducing the risk of GI symptoms in critically ill patients.</p><p><strong>Objective: </strong>This study aimed to evaluate their comparative effects in preventing GI symptoms and improving clinical outcomes.</p><p><strong>Methods: </strong>MEDLINE, CENTRAL, and Web of Science were searched through June 2025. Eligible randomized controlled trials enrolled critically ill adults and compared prebiotics, probiotics, or synbiotics with controls (placebo or usual care). The primary outcome was GI symptom incidence. Secondary outcomes included mortality, intensive care unit (ICU) length of stay, mechanical ventilation duration, infectious complications, and adverse events. A frequentist random-effects NMA was conducted. Treatment rankings were exploratory, and certainty of evidence was not formally assessed.</p><p><strong>Results: </strong>Thirty-three randomized controlled trials involving 5,073 patients were included in the analysis of GI symptoms. Compared with control, synbiotics significantly reduced the risk of GI symptoms (risk ratio [RR] 0.52; 95% confidence interval [CI]: 0.35 to 0.77), as did prebiotics (RR 0.66; 95% CI: 0.49 to 0.87). Probiotics produced a similar directional effect, but the difference was not statistically significant (RR 0.81; 95% CI: 0.60 to 1.10). No significant differences were found between the active interventions. Subgroup analyses suggested differences according to the ICU population. Among medical intensive care patients, prebiotics were associated with a lower risk of GI symptoms than control, whereas probiotics and synbiotics were associated with a lower risk among surgical intensive care patients.</p><p><strong>Conclusions: </strong>Synbiotics and prebiotics were associated with a significantly lower risk of gastrointestinal symptoms in critically ill patients, whereas probiotics showed a similar but statistically nonsignificant effect. No active intervention was significantly superior to another. The findings suggest that the relative benefits of these interventions may differ between medical and surgical intensive care populations. Nevertheless, the results should be interpreted cautiously because certainty of evidence was not formally assessed.PROSPERO registration number: CRD420251015729; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251015729.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100130"},"PeriodicalIF":6.9,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose-response relationship of pre-ICU corticosteroids and influenza-associated pulmonary aspergillosis: a multicenter target trial emulation.","authors":"Shengnan Xu, Hongmei Liu, Pengli Fan, Hao Dou, Leilei Guo, Bo Qiao, Yuanyuan Li, Yansheng Zhou, Xiufeng Hu, Yanyan Guo, Bin Hu, Sangang Zheng, Junping Liu, Jiangfeng Zhang, Junzhe Bao, Peng Li","doi":"10.1016/j.aicoj.2026.100132","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100132","url":null,"abstract":"<p><strong>Background: </strong>Prior corticosteroid use is linked to influenza-associated pulmonary aspergillosis (IAPA) in critically ill patients, yet the dose-response relationship remains unclear.</p><p><strong>Methods: </strong>In this multicenter emulated target trial across 48 ICUs in Central China (January 2023-June 2025), we included critically ill, non-neutropenic adults with influenza. Using inverse probability of treatment weighting (IPTW) and restricted cubic splines, we modeled the dose-response association between pre-ICU corticosteroid exposure and IAPA, identifying risk thresholds via segmented regression. Effect modification by pre-specified patient characteristics was further assessed.</p><p><strong>Results: </strong>Among 2763 patients (74.2% exposed to corticosteroids; median dose 35 mg dexamethasone-equivalent), 191 (6.9%) developed IAPA during their ICU stay. Pre-ICU corticosteroid exposure was independently associated with IAPA (weighted HR = 2.11; 95% CI 1.25-3.56). A non-linear, J-shaped dose-response relationship was identified (P < 0.001). Risk increased continuously, with a 50% increase at 43.4 mg and doubling at 51.4 mg, followed by a steep inflection point at 63.7 mg (95% CI 62.8-64.7). Higher SOFA scores (>7) significantly amplified per-dose risk (P < 0.001), lowering thresholds to 35.2 mg for 50% increase and 39.5 mg for doubling.</p><p><strong>Conclusions: </strong>Pre-ICU corticosteroid exposure is associated with a nonlinear, dose-dependent increase in IAPA risk. Cumulative doses approaching 40-50 mg warrant heightened vigilance, particularly in severely ill patients. These findings support individualized, dose-aware corticosteroid stewardship in severe influenza.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100132"},"PeriodicalIF":6.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"French intensive care physicians' practices for the management of high-risk patients with invasive candidiasis: results from the multicenter INSPIRE survey.","authors":"Hervé Dupont, Jean-Paul Mira, Muriel Cornet, Sandrine Girardot-Seguin, Nour El Khatib, Karine Gouhier, Emmanuel Novy","doi":"10.1016/j.aicoj.2026.100131","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100131","url":null,"abstract":"<p><strong>Background: </strong>Candidiasis remains a major global health challenge, with rising incidence and antifungal resistance complicating management. This multicenter survey aimed to describe diagnostic and therapeutic management practices of ICU physicians in France for high-risk invasive candidiasis cases, using randomized clinical case simulations distributed to French ICU physicians via email and academic congresses.</p><p><strong>Results: </strong>A total of 75 physicians completed 283 cases. Overall, clinical suspicion justified diagnostic investigation in 72.1% of cases. Key factors associated with the decision to test for invasive candidiasis included post-abdominal surgery (OR = 3.92; p = 0.002), central venous catheter (OR = 2.28; p = 0.04), parenteral nutrition (OR = 2; p = 0.027), prolonged antibiotic exposure (OR = 1.90; p = 0.041), and physician experience >10 years (OR = 2.79; p = 0.014). Echinocandins were the preferred first-line treatment (88.2%; n = 120/136). Their use was guided by clinical guidelines (78.3%), pharmacokinetic/pharmacodynamic profile (38.3%), SOFA score (29.2%), patient status (25.8%), and immunosuppression (20%). De-escalation to azoles upon documented mycological susceptibility occurred in 87.5% of cases initially treated with an echinocandin and 60.0% of cases initiated on amphotericin B, primarily after 5 days of treatment (51.2%; n = 64).</p><p><strong>Conclusions: </strong>Patient severity, immunosuppression, and catheter presence were the main factors guiding antifungal treatment decisions Management of confirmed invasive candidiasis was largely consensual among respondents, whereas empirical treatment decisions were heterogeneous. While conclusions are primarily reflective of practice patterns within specialized university hospital centers, the INSPIRE survey highlights the need for enhanced training, broader access to rapid diagnostics, and improved decision-support systems to better harmonize clinical practices.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100131"},"PeriodicalIF":6.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}