---
title: "Invasive candidiasis in the ICU: diagnostic stewardship, source control, and precision antifungal"
id: "pubmed-42667299"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42667299"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42667299/"
doi: "10.1080/14787210.2026.2726965"
published_at: "2026-08-29T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Invasive candidiasis in the ICU: diagnostic stewardship, source control, and precision antifungal
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42667299
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42667299/)
- **DOI:** [10.1080/14787210.2026.2726965](https://doi.org/10.1080%2F14787210.2026.2726965)
- **Published At:** 2026-08-29T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Invasive candidiasis remains a major diagnostic and therapeutic challenge in the intensive care unit due to nonspecific clinical signs, frequent colonization, altered host immunity, complex infection sources and variable pharmacokinetics. - Distinguishing true **invasive candidiasis** from colonization is essential to improve outcomes and avoid unnecessary antifungal exposure. - This article is a narrative review based on a structured PubMed/MEDLINE, Embase and Cochrane search of English-language literature from January 2005 to May 2026. - The review covers contemporary epidemiology, updated fungal nomenclature, risk factors and disease phenotypes relevant to critically ill adults. - Diagnostic stewardship topics include conventional cultures, **beta-D-glucan** assays and molecular diagnostics; the authors emphasize interpreting positive tests in clinical and anatomical context rather than treating laboratory positivity alone. - Management discussions address **source control**, including catheter management, and the balance between empirical and targeted antifungal therapy. - Pharmacologic considerations include **therapeutic drug monitoring**, pharmacokinetic challenges during extracorporeal support, and implications for dosing and agent selection. - The review examines emerging antifungal agents and specific concerns about **Candida auris** as an ICU pathogen. - The authors’ expert opinion highlights that the central problem is accurate attribution of invasive disease, and they recommend integrated strategies combining rapid diagnostics, host immune profiling, optimized pharmacokinetics and effective source control within phenotype-driven care while reinforcing **antifungal stewardship**.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Invasive candidiasis in the Intensive Care unit: diagnostic stewardship, source control, and precision antifungal therapy [Ignacio Martin-Loeches](https://pubmed.ncbi.nlm.nih.gov/?term=Martin-Loeches+I&cauthor_id=42667299)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42667299/#full-view-affiliation-1 "Department of Intensive Care Medicine, St James's Hospital, Dublin, Ireland.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42667299/#full-view-affiliation-2 "School of Medicine, Trinity College Dublin, Dublin, Ireland."), [Yuetian Yu](https://pubmed.ncbi.nlm.nih.gov/?term=Yu+Y&cauthor_id=42667299)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42667299/#full-view-affiliation-3 "Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42667299/#full-view-affiliation-4 "Department of Pharmacy, Changxing People's Hospital, Changxing Branch, Second Affiliated Hospital of Zhejiang University School of Medicine, Huzhou, China.") Affiliations Expand ### Affiliations * 1 Department of Intensive Care Medicine, St James's Hospital, Dublin, Ireland. * 2 School of Medicine, Trinity College Dublin, Dublin, Ireland. * 3 Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. * 4 Department of Pharmacy, Changxing People's Hospital, Changxing Branch, Second Affiliated Hospital of Zhejiang University School of Medicine, Huzhou, China. * PMID: **42667299** * DOI: [ 10.1080/14787210.2026.2726965 ](https://doi.org/10.1080/14787210.2026.2726965) Item in Clipboard Review # Invasive candidiasis in the Intensive Care unit: diagnostic stewardship, source control, and precision antifungal therapy Ignacio Martin-Loeches et al. Expert Rev Anti Infect Ther. 2026. Show details Display options Display options Format Abstract PubMed PMID Expert Rev Anti Infect Ther Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Expert+Rev+Anti+Infect+Ther%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Expert+Rev+Anti+Infect+Ther%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42667299/) . 2026 Aug 29. doi: 10.1080/14787210.2026.2726965. Online ahead of print. ### Authors [Ignacio Martin-Loeches](https://pubmed.ncbi.nlm.nih.gov/?term=Martin-Loeches+I&cauthor_id=42667299)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42667299/#short-view-affiliation-1 "Department of Intensive Care Medicine, St James's Hospital, Dublin, Ireland.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42667299/#short-view-affiliation-2 "School of Medicine, Trinity College Dublin, Dublin, Ireland."), [Yuetian Yu](https://pubmed.ncbi.nlm.nih.gov/?term=Yu+Y&cauthor_id=42667299)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42667299/#short-view-affiliation-3 "Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42667299/#short-view-affiliation-4 "Department of Pharmacy, Changxing People's Hospital, Changxing Branch, Second Affiliated Hospital of Zhejiang University School of Medicine, Huzhou, China.") ### Affiliations * 1 Department of Intensive Care Medicine, St James's Hospital, Dublin, Ireland. * 2 School of Medicine, Trinity College Dublin, Dublin, Ireland. * 3 Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. * 4 Department of Pharmacy, Changxing People's Hospital, Changxing Branch, Second Affiliated Hospital of Zhejiang University School of Medicine, Huzhou, China. * PMID: **42667299** * DOI: [ 10.1080/14787210.2026.2726965 ](https://doi.org/10.1080/14787210.2026.2726965) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Introduction:** Invasive candidiasis remains one of the most challenging infections in the intensive care unit (ICU) because diagnosis is complicated by nonspecific clinical manifestations, frequent colonization, altered host immunity, complex anatomical sources and unstable pharmacokinetics. Distinguishing true invasive disease from colonization is fundamental to optimizing patient outcomes while avoiding unnecessary antifungal exposure. **Areas covered:** This narrative review examines invasive candidiasis in critically ill adults from an ICU perspective, based on a structured PubMed/MEDLINE, Embase and Cochrane Library search of English-language literature (January 2005-May 2026). We discuss contemporary epidemiology, updated fungal nomenclature, risk factors and disease phenotypes, together with diagnostic stewardship using cultures, beta-D-glucan and molecular assays. Current evidence regarding source control, catheter management, empirical and targeted antifungal therapy, therapeutic drug monitoring, pharmacokinetic challenges during extracorporeal support, emerging agents and Candida auris is reviewed. **Expert opinion:** The principal challenge in ICU fungal infections is not delayed antifungal therapy alone but accurate attribution of invasive disease. Positive fungal cultures or biomarkers should be interpreted within their clinical and anatomical context rather than as independent indications for treatment. Future management should integrate rapid diagnostics, host immune profiling, optimized pharmacokinetics and effective source control into phenotype-driven strategies that improve outcomes while strengthening antifungal stewards. **Keywords:** Candida; Invasive candidiasis; antifungal stewardship; candidemia; candidozyma auris; intensive care; source control; therapeutic drug monitoring. 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