Diagnosis and management of invasive candidiasis in critically ill patients: SIAARTI multidisciplinary statement

TL;DR

This paper provides a multidisciplinary guide for diagnosing and managing invasive candidiasis in critically ill patients to improve outcomes.

Contribution

The paper introduces a consensus-based framework for tailored management of invasive candidiasis in ICU patients.

Findings

A multidisciplinary panel formulated 13 statements on diagnosis and management of invasive candidiasis.

The guidance includes optimal antifungal selection and use of therapeutic drug monitoring.

Special attention is given to site-specific infections like peritoneal and biofilm-associated infections.

Abstract

Critically ill patients in Intensive Care Units are at high risk of developing invasive candidiasis (IC). Delay in diagnosis and suboptimal management contribute to high mortality rates, highlighting the need for an appropriate and patient-tailored approach. The Italian Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) convened a multidisciplinary panel, involving intensivists, infectious disease specialists, microbiologists, and pharmacologists, to develop consensus-based statements on the diagnosis and management of IC in critically ill patients. The panel formulated 13 statements addressing key aspects of care, including identification of major risk factors for IC, the role of biomarkers to support therapeutic decision-making, and optimal selection of antifungal agents based on pharmacokinetic/pharmacodynamic (PK/PD) considerations and site-specific characteristics. The document also provides guidance on the use of therapeutic drug monitoring (TDM) to optimize antifungal efficacy. Special attention is given to infections in specific anatomical sites, such as the peritoneal cavity, central nervous system, eye, and biofilm-associated infections, where drug penetration and activity must be carefully considered. This multidisciplinary statement offers a practical framework aimed at improving clinical decision-making for the management of invasive candidiasis in critically ill patients.

The online version contains supplementary material available at 10.1186/s44158-025-00299-y.