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  • Candida species are increasingly important causes of infection in the ICU.

  • Candida albicans is the most common cause of candidemia and invasive candidiasis in ICU patients, but in the last two decades, non-albicans Candida species, especially Candida glabrata, have increased in prominence.

  • The risk factors for Candida infections in the ICU include extremes of age, trauma, burns, high APACHE II score, recent abdominal surgery, gastrointestinal tract perforation, pancreatitis, mechanical ventilation, central venous catheters, parenteral nutrition, dialysis, and broad-spectrum antibiotic therapy.

  • Rapid diagnosis of candidemia is essential to decrease mortality rates. Newer nonculture-based techniques have the potential to improve diagnosis, but are not widely available.

  • All patients with documented candidemia should be treated with an antifungal agent. Prompt treatment of candidemia is important; delay for 24 hours or more after blood cultures are obtained is associated with increased mortality.

  • All patients who have documented candidemia should have a dilated eye examination by an ophthalmologist to determine whether metastatic infection is present in the eye.

  • Prompt removal of central venous catheters in patients with candidemia leads to more rapid clearing of the organism from blood and improved outcomes.

  • Initial treatment of candidemia should be with an echinocandin. Therapy can be changed to fluconazole after several days only if the organism is shown to be fluconazole susceptible, the blood cultures have become negative, and the patient is clinically improved.

  • Candiduria is common in the ICU and is mostly related to the use of indwelling bladder catheters and broad-spectrum antimicrobial agents. The vast majority of patients who are candiduric are colonized, do not develop upper tract infection or candidemia, and do not require treatment.

  • Aspergillus spp. infections in non-neutropenic patients (including those with chronic obstructive pulmonary disease, use of corticosteroids, and cirrhosis) are challenging to diagnose and can be associated with high rates of morbidity and mortality.


Invasive fungal infections are an increasingly prevalent problem in hospitalized patients, especially those in intensive care units (ICU).1–7 The most common organisms causing infections of patients in the ICU are Candida species. Reasons for the increase in Candida infections in ICU patients over the last several decades include the expanding numbers of immunocompromised patients, longer survival of patients who have multiple medical problems, increased use of devices and invasive procedures that disrupt the host’s natural barriers to infection, and the adverse effects of broad-spectrum antimicrobial agents on the normal human microbiota.

Far less frequently seen are infections due to Aspergillus species; however, there are increasing reports of invasive aspergillosis in non-neutropenic ICU patients, especially those who have severe infections caused by influenza or SARS-Cov-2.8–11 Additionally, patients who have other fungal infections causing severe respiratory disease require ICU care occasionally. The main focus of this chapter will be on the commonly encountered Candida infections with a few comments on invasive aspergillosis at the end of the chapter.


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