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ESICM/ESCMID task force on practical management of invasive candidiasis in critically ill patients

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Abstract

Introduction

The term invasive candidiasis (IC) refers to both bloodstream and deep-seated invasive infections, such as peritonitis, caused by Candida species. Several guidelines on the management of candidemia and invasive infection due to Candida species have recently been published, but none of them focuses specifically on critically ill patients admitted to intensive care units (ICUs).

Material and Methods

In the absence of available scientific evidence, the resulting recommendations are based solely on epidemiological and clinical evidence in conjunction with expert opinion. The task force used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to evaluate the recommendations and assign levels of evidence. The recommendations and their strength were decided by consensus and, if necessary, by vote (modified Delphi process). Descriptive statistics were used to analyze the results of the Delphi process. Statements obtaining > 80% agreement were considered to have achieved consensus.

Conclusions

The heterogeneity of this patient population necessitated the creation of a mixed working group comprising experts in clinical microbiology, infectious diseases and intensive care medicine, all chosen on the basis of their expertise in the management of IC and/or research methodology. The working group’s main goal was to provide clinicians with clear and practical recommendations to optimize microbiological diagnosis and treatment of IC. The Systemic Inflammation and Sepsis and Infection sections of the European Society of Intensive Care Medicine (ESICM) and the Critically Ill Patients Study Group of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) therefore decided to develop a set of recommendations for application in non-immunocompromised critically ill patients.

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Authors and Affiliations

  1. Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, Dublin, Ireland

    Ignacio Martin-Loeches

  2. Hospital Clinic, Universidad de Barcelona, CIBERes, Barcelona, Spain

    Ignacio Martin-Loeches

  3. Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Massimo Antonelli

  4. Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain

    Manuel Cuenca-Estrella

  5. Department of Critical Care, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens, Greece

    George Dimopoulos

  6. General Intensive Care Unit, Shaare Zedek Medical Centre and the Hebrew University Faculty of Medicine, Jerusalem, Israel

    Sharon Einav

  7. Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium

    Jan J. De Waele

  8. Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain

    Jose Garnacho-Montero

  9. Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain

    Jose Garnacho-Montero

  10. Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon

    Souha S. Kanj

  11. Anesthesiology, Pain and Intensive Care Department, Federal University of Sao Paulo, Sao Paulo, Brazil

    Flavia R. Machado

  12. Paris Diderot, Sorbonne Cite University, and Anaesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP, INSERM, UMR 1152, Paris, France

    Philippe Montravers

  13. Department of Anesthesiology and Intensive Care, Uniklinikum Jena, Jena, Germany

    Yasser Sakr

  14. Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Institute of Microbiology, Rome, Italy

    Maurizio Sanguinetti

  15. UMR 1137, IAME Inserm/University Paris Diderot, Paris, France

    Jean-Francois Timsit

  16. APHP, Bichat Hospital, Intensive Care Unit, Paris, France

    Jean-Francois Timsit

  17. Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy

    Matteo Bassetti

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  1. Ignacio Martin-Loeches
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Correspondence to Ignacio Martin-Loeches.

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Conflicts of interest

COIs declared by the authors: IML: Lectures: Thermofisher, Polyphor, J&J, Virogates, MSD. Advisory board: Fresenius Kabi, MaaT Pharma, Bayer, Gilead, Clinigen, Biotest, Accelerate. JGM has received speaker honoraria from Astellas and MSD. MB has participated in the past five years in advisory boards and/or received speaker honoraria from Achaogen, Angelini, Astellas, AstraZeneca, Bayer, Basilea, Cidara, Gilead, Menarini, MSD, Nabriva, Paratek, Pfizer, Roche, The Medicine Company, Shionogi, Tetraphase, VenatoRx, and Vifor. SSK has received honoraria for participating in advisory boards or as a speaker for Merck, Pfizer, Hikma, Pasteur Aventis, Gilead. JDW has consulted for Accelerate, AtoxBio, Bayer Healthcare, Cubist, MSD, Pfizer (honoraria were paid to his institution). PM: Personal fees and non-financial support from Astellas, Astrazeneca, Basilea, Bayer, Cubist, Menarini, MSD, Parexel, Pfizer, Tetraphase, and The Medicines Company unrelated to the submitted work. GD: Advisory boards and/or received speaker honoraria from Astellas, Bayer, Cidara, Gilead, MSD, Nabriva, Paratek, Pfizer, Tetraphase, Cipla India, Glenmark India, Infectopharm Germany. MCE has received grant support from Astellas Pharma, bioMerieux, Gilead Sciences, Merck Sharp & Dohme, Pfizer, Schering Plough, CIDARA, Amplyx, F2G, Scynexis, Soria Melguizo SA, and Ferrer International. He is a founding Partner of the start-up Micología Molecular SL.

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Martin-Loeches, I., Antonelli, M., Cuenca-Estrella, M. et al. ESICM/ESCMID task force on practical management of invasive candidiasis in critically ill patients. Intensive Care Med 45, 789–805 (2019). https://doi.org/10.1007/s00134-019-05599-w

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