Invasive fungal infections in the intensive care unit

Invasive fungal infections, especially candidemia and systemic candidiasis, have become a major cause of morbidity and mortality in the last few decades. This comes in parallel with the major advances made in intensive care. Patients who are critically ill, in medical or surgical ICUs are especially at risk for Candida infections. Invasive candidiasis accounts for up to 15 to 30% of all nosocomial infections in critically ill patients. Management of these severe infections has been challenging due to a lack of rapid and reliable diagnostic methods, leading to delays in initiating appropriate antifungal therapy. However, some notable improvements have been made in diagnostics with improved culturing methods, rapid species identification, and detection of fungemia with newer antigen assays. Newer classes of antifungals have recently become available with broader antifungal activity, fewer drugdrug interactions, and improved tolerability when compared with the older antifungal agents. Despite these advancements, the mortality rates associated with candidiasis remain excessively high, with an overall mortality in the range of 30 to 50% and an attributable mortality of ∼30%. In addition to this high case-fatality rate, candidemia is also associated with a substantial economic burden, primarily due to an extended length of stay. Strategies to evaluate either the prevention, early diagnosis, or initiation of appropriate therapy should yield both clinical and socioeconomic benefits.