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Candidemia and invasive candidiasis in adults: A narrative review

      Highlights

      • Invasive candidiasis is an increasingly recognized health-care associated infection.
      • Five Candida species cause more than 90% of cases.
      • Blood cultures have low sensitivity for the diagnosis of invasive candidiasis.
      • Clinical score and non-culture-based diagnostic assays might improve early diagnosis.
      • Echinocandins are the treatment of choices for most cases of invasive candidiasis.

      Abstract

      Candidemia and invasive candidiasis are major causes of morbidity and mortality, and their incidence is increasing because of the growing complexity of patients. Five species of Candida (Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis and Candida krusei) account for more than 90% of all diagnosed cases, but their relative frequency varies depending on the population involved, geographical region, previous anti-fungal exposure, and patient age. The best evidence regarding the anti-fungal treatment for invasive candidiasis comes from randomized controlled trials in which more than 85% of the recruited patients had candidemia. In the case of less frequent forms of invasive candidiasis, the recommendations are based on retrospective studies, meta-analyses (when available) and experts' opinions. A pre-emptive approach based on biomarkers and clinical rules is recommended because of the high rate of infection-related mortality among critically ill patients.

      Keywords

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