Invasive candidiasis in critically ill patients

Invasive fungal infections are an increasingly frequent etiology of sepsis in critically ill patients causing substantial morbidity and mortality. The epidemiology of species responsible for invasive candidiasis has been changing - shifting from Candida albicans to non-albicans species, which can be resistant to fluconazole or difficult to eradicate because of biofilm production. Numerous intensive care unit patients have multiple risk factors for developing this infection, which include prolonged hospitalisation, presence of intravascular catheters, parenteral nutrition , use of broad-spectrum antibiotics, hemodialysis …. Early diagnosis of invasive candidiasis is critical in order to initiate antifungal agents promptly. Delay in the administration of appropriate therapy increases mortality. New diagnostics are needed to complement cultures. Mannan/anti-mannan, β-D-glucan (BDG) and polymerase chain reaction (PCR) assays, with a promising sensitivity/specificity, can diagnose candidemia before blood cultures and identify patients who are blood culture-negative.