INVASIVE candidiasis remains a significant challenge for intensive care units worldwide due to its high mortality rate, diagnostic complexity, and increasing resistance. A new 2024 nationwide survey sheds light on how French ICU teams are grappling with this life-threatening infection and where major gaps in bedside practice remain.
The cross-sectional study surveyed senior physicians from 221 ICUs across France, achieving a 54.7% response rate. Among the 121 intensivists who responded, 75 provided complete data that paints a complex picture of current practices. These clinicians, most of whom work in public hospitals and frequently manage hematological oncology patients, reported strengths in collaborative care but notable inconsistencies in using available diagnostic and therapeutic tools.
Notably, while 74% of respondents stated that multidisciplinary staff meetings are regularly organized, the inclusion of mycologists was rare, potentially weakening infection management strategies. Rapid diagnostic tools such as serum (1,3)-β-D-glucan were accessible to 75% of respondents, yet incorporating these results into real-time decision-making remains limited. This diagnostic disconnect may contribute to delays in treatment initiation or misdirection in care.
Therapeutic drug monitoring (TDM), a cornerstone of antifungal stewardship, was available to 67% of respondents, with voriconazole as the most frequently monitored drug. Yet only 9.1% reported access to TDM every day of the week, a limitation that may hinder optimal dosing and increase the risk of resistance or toxicity.
The survey emphasizes the need for enhanced integration of diagnostic tools into ICU workflows, improved access to TDM, and broader inclusion of mycology expertise in multidisciplinary care. These changes could significantly improve patient outcomes, reduce antifungal resistance, and strengthen stewardship efforts in critical care settings.
Reference:
Esposito M et al. Management of invasive candidiasis in French ICUs: insights from a 2024 nationwide survey. Eur J Clin Microbiol Infect Dis. 2025. doi: 10.1007/s10096-025-05169-7. [Online ahead of print].
