Consensus statement on the management of invasive candidiasis in Indian scenario
Keywords:Candida strains, Caspofungin, Invasive candidiasis, Non-culture tests, Matrix assisted laser desorption/ionization- time of flight
Invasive fungal infections in critically ill patients are associated with increased morbidity and mortality. Candida species are among the most common causes of nosocomial bloodstream infections and of invasive infections in intensive care units (ICUs). The high mortality mandates early identification of invasive candidiasis which is vital to initiate appropriate and timely treatment and improve outcomes. Delaying the initiation of treatment could result in an increase in mortality which can be avoided by usage of more rapid diagnostic techniques. There are multiple diagnostic tests including culture and non-culture tests like 1,3-β-D-glucan and newer techniques like MALDI-TOF which are available to diagnose candidemia but each with their drawbacks. Additionally, there are various guidelines like IDSA and ESCMID on treatment which aim to minimize death, late complications from deep-seated candidiasis and rise of drug- resistant Candida strains. Through this consensus statement prepared by a panel of experts, all of whom are senior intensivists, infectious disease specialists and microbiologists, we aim to address the major aspects of management of invasive candidiasis in the Indian population as per the authors opinions, backed by published evidence and supported by the latest clinical guidelines.
Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G. Invasive fungal infections in the ICU: how to approach, how to treat. Molecules. 2014 Jan;19(1):1085-119.
Bajwa SJ, Kulshrestha A. Fungal infections in intensive care unit: challenges in diagnosis and management. Ann Medi Health Sci Res. 2013 Apr;3(2):238-44.
Lamoth F, Lockhart SR, Berkow EL, Calandra T. Changes in the epidemiological landscape of invasive candidiasis. J Antimicr Chemoth. 2018 Jan 1;73(suppl_1):i4-i13.
Ahmed A, Azim A, Baronia AK, Marak RS, Gurjar M. Invasive candidiasis in non-neutropenic critically ill-need for region-specific management guidelines. Indian J Crit Care Med: Peer-Reviewed, Official Publication Indian Soci Crit Care Med. 2015 Jun;19(6):333-9.
Tsay S, Kallen A, Jackson BR, Chiller TM, Vallabhaneni S. Approach to the investigation and management of patients with Candida auris, an emerging multidrug-resistant yeast. Clini Infect Dis. 2017 Aug 17;66(2):306-11.
Chakrabarti A, Sood P, Rudramurthy SM, Chen S, Kaur H, Capoor M, et al. Incidence, characteristics and outcome of ICU-acquired candidemia in India. Intensive Care Med. 2015 Feb 1;41(2):285-95.
Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicro Agents Chemother. 2005 Sep 1;49(9):3640-5.
Calandra T, Roberts JA, Antonelli M, Bassetti M, Vincent JL. Diagnosis and management of invasive candidiasis in the ICU: an updated approach to an old enemy. Crit Care. 2016 Dec;20(1):125..
Kauffman CA. Clinical manifestations and diagnosis of candidemia and invasive candidiasis in adults. 2018. Available at: https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-candidemia-and-invasive-candidiasis-in-adults. Accessed on 27 August 2018.
Clancy CJ, Nguyen MH. Diagnosing invasive candidiasis. J Clin Microbiol. 2018 May;56(5): e01909-17.
Eggimann P, Bille J, Marchetti O. Diagnosis of invasive candidiasis in the ICU. Ann Intens Care. 2011 Dec 1;1(1):37.
Badiee P, Hashemizadeh Z. Opportunistic invasive fungal infections: diagnosis and clinical management. Indian J Medi Res. 2014 Feb;139(2):195-204.
Ben-Ami R. Treatment of invasive candidiasis: A narrative review. J Fungi. 2018 Sep;4(3):97.
Osthoff M, Khanna N, Siegemund M. The EMPIRICUS trial-the final nail in the coffin of empirical antifungal therapy in the intensive care unit?. J Thoracic Dis. 2017 Mar;9(3):E269-73.
Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clini Infect Dis. 2015 Dec 16;62(4):e1-50.
Kauffman CA. Management of candidemia and invasive candidiasis in adults. Available at: https://www.uptodate.com/contents/management-of-candidemia-and-invasive-candidiasis-in-adults. Accessed on 27 August 2018.
Scott LJ. Micafungin: a review of its use in the prophylaxis and treatment of invasive Candida infections. Drugs. 2012 Nov 12;72(16):2141-65.
Yeoh SF, Lee TJ, Chew KL, Lin S, Yeo D, Setia S. Echinocandins for management of invasive candidiasis in patients with liver disease and liver transplantation. Infect Drug Resist. 2018;11:805-81.
Bassetti M, Righi E, Montravers P, Cornely OA. What has changed in the treatment of invasive candidiasis? A look at the past 10 years and ahead. J Antimicrob Chemother. 2018 Jan 1;73(suppl_1):i14-25.