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What’s new in the clinical and diagnostic management of invasive candidiasis in critically ill patients

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Abstract

Invasive candidiasis (IC) is a severe complication in the ICU setting. A high proportion of ICU patients become colonized with Candida species, but only 5–30 % develop IC. Progressive colonization and major abdominal surgery are well-known risk factors for Candida infection. IC is difficult to predict and early diagnosis remains a major challenge. In addition, microbiological documentation often occurs late in the course of infection. Delays in initiating appropriate treatment have been associated with increased mortality. In an attempt to decrease Candida-related mortality, an increasing number of critically ill patients without documented IC receive empirical systemic antifungal therapy, leading to concern for antifungal overuse. Scores/predictive rules permit the stratification and selection of IC high-risk patients who may benefit from early antifungal therapy. However, they have a far better negative predictive value than positive predictive value. New IC biomarkers [mannan, anti-mannan, (1,3)-β-d-glucan, and polymerase chain reaction] are being increasingly used to enable earlier diagnosis and, ideally, to provide prognostic information and/or therapeutic monitoring. Although reasonably sensitive and specific, these techniques remain largely investigational, and their clinical usefulness has yet to be established.

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Abbreviations

IC:

Invasive candidiasis

IAC:

Intra-abdominal candidiasis

BG:

(1,3)-β-d-Glucan

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Acknowledgments

The authors thank Marta Pulido, MD, for editing the manuscript and editorial assistance.

Conflicts of interest

CL received research grants and/or educational grants and/or speaker’s honoraria and/or consultant’s honoraria from (in alphabetic order) Astellas, Merck, and Pfizer. LO has received research grants from Merck, Astellas, Pfizer, Associates of Cape Cod and T2 Biosystems and speaking or consulting fees from Merck, Astellas, and Pfizer. MS no conflicts of interest.

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  1. ICU-Valme University Hospital, University of Seville, Avda Bellavista s/n, 41014, Seville, Spain

    Cristóbal León

  2. Division of Infectious Diseases, Memorial Hermann Texas Medical Center, University of Texas Medical School at Houston, Houston, TX, 77030, USA

    Luis Ostrosky-Zeichner

  3. Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, USA

    Mindy Schuster

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  1. Cristóbal León
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Correspondence to Cristóbal León.

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León, C., Ostrosky-Zeichner, L. & Schuster, M. What’s new in the clinical and diagnostic management of invasive candidiasis in critically ill patients. Intensive Care Med 40, 808–819 (2014). https://doi.org/10.1007/s00134-014-3281-0

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