Empirical Therapy for Invasive Candidiasis in Critically Ill Patients

In this narrative review, we discuss recent literature regarding early antifungal therapy in critically ill patients, focusing in particular on the current role of empirical antifungal treatment.

While the direction of effect in randomized controlled trials (RCTs) exploring efficacy of empirical therapy in intensive care unit (ICU) patients with suspected invasive candidiasis (IC) was most frequently toward a favorable impact of empirical therapy, no formal demonstration of superiority was observed.

Main results from RCTs seem in contrast with the increased mortality reported from observational studies in case of delayed antifungal therapy in patients with IC, suggesting, in our opinion, that further research is still necessary to better delineate the precise subgroup of ICU patients with suspected IC who may benefit from early antifungal therapy, either early empirical based on risk scores or diagnostic-driven, or a combination of both.