Invasive candidiasis: current clinical challenges and unmet needs in adult populations

Abstract

Invasive candidiasis (IC) is a serious infection caused by several Candida species, and the most common fungal disease in hospitals in high-income countries. Despite overall improvements in health systems and ICU care in the last few decades, as well as the development of different antifungals and microbiological techniques, mortality rates in IC have not substantially improved. The aim of this review is to summarize the main issues underlying the management of adults affected by IC, focusing on specific forms of the infection: IC developed by ICU patients, IC observed in haematological patients, breakthrough candidaemia, sanctuary site candidiasis, intra-abdominal infections and other challenging infections. Several key challenges need to be tackled to improve the clinical management and outcomes of IC patients. These include the lack of global epidemiological data for IC, the limitations of the diagnostic tests and risk scoring tools currently available, the absence of standardized effectiveness outcomes and long-term data for IC, the timing for the initiation of antifungal therapy and the limited recommendations on the optimal step-down therapy from echinocandins to azoles or the total duration of therapy. The availability of new compounds may overcome some of the challenges identified and increase the existing options for management of chronic Candida infections and ambulant patient treatments. However, early identification of patients that require antifungal therapy and treatment of sanctuary site infections remain a challenge and will require further innovations.

Outcomes by Candida spp. in the ReSTORE Phase 3 trial of rezafungin versus caspofungin for candidemia and/or invasive candidiasis

“…account for most cases —C. albicans , Nakaseomyces glabratus (the previous classification as C. glabrata is retained in this report), Pichia kudriavzevii (termed C. krusei herein), C. tropicalis , and C. parapsilosis —although C. auris has also demonstrated high potential for nosocomial transmission since its emergence ( 1 , 2 ).…”

“…Commensal Candida species (spp.) are present on the skin and mucosa of 50%–70% of healthy individuals, but invasive candidiasis (IC), encompassing candidemia and infection of deep tissues, can occur as an opportunistic infection in immunocompromised or immunosuppressed individuals ( 1 , 2 ). In healthcare settings, IC and candidemia are among the most frequently seen fungal diseases and bloodstream infections, respectively, and are associated with substantial morbidity and mortality ( 1 – 3 ).…”

Secreted Aspartic Proteinases: Key Factors in Candida Infections and Host-Pathogen Interactions

“…2024, 25, 4775 2 of 25 individuals affected by other serious medical conditions. One such infection of nosocomial emergence is invasive candidiasis, with a worldwide frequency of up to half a million individuals each year and mortality rates close to 55% [7,8]. While C. albicans still constitutes the most common cause of candidiasis worldwide, non-albicans Candida species are presently increasingly identified, and for C. auris, there has been an expansive increase in the incidence of infections over the last decade [9][10][11][12].…”

Salvage Therapy with Rezafungin for Candida parapsilosis Spondylodiscitis: A Case Report from Expanded Access Program

“…and includes both candidemia and deep-seated tissue candidiasis, which arises from the dissemination of Candida spp. to a sterile body site (e.g., endocarditis, peritonitis, endophthalmitis) [2].…”