From 2012 ESCMID to global 2025 ECMM/ISHAM/ASM Candida guidelines: What are the key differences & practical implications?

The unity of the global 2025 ECMM/ISHAM/ASM Candida guideline (global Candida 2025 guideline) means a practitioner can find all important topics in one document, whereas in 2012 one had to consult multiple papers for each subgroup. The global Candida 2025 guideline retains echinocandins as the first-line treatment for invasive candidiasis while incorporating new agents – such as rezafungin for once-weekly dosing and novel oral options for resistant infections – to offer more personalized, susceptibility-guided therapy. They also recommend an earlier intravenous-to-oral step-down in stable non-neutropenic patients, and emphasize the need for prompt source control. Additionally, there is a stronger focus on managing emerging resistance (notably with Candida auris and azole-resistant Candida parapsilosis) and tailoring prophylaxis and treatment strategies to local epidemiology and special patient populations. It provides detailed, evidence-graded recommendations using the GRADE system, with explicit sections on emerging pathogens, resistance, antifungal stewardship, and infection control. The global Candida 2025 guideline incorporates broader public health considerations and guidance on resource-limited settings.