ABSTRACT
Most cases of invasive candidiasis (IC) occur in immunocompromised patients, such as recipients of solid organ transplants. Despite advances in therapy, mortality for IC can be as high as 72%. The global epidemiology of IC is evolving, with a progressive shift from Candida albicans to non-albicans Candida spp. The recent emergence of multidrug-resistant Candida auris has caused great concern and highlights the need for active surveillance and better therapeutic agents. The diagnosis of IC requires a combination of diagnostic tests and patient risk factors. Both β-D glucan and germ tube antibody are used as biomarkers to aid in diagnosis, although direct culture is still the gold standard. When choosing antifungal therapy, the clinician must not only consider resistance but also the shifting predominance of Candida albicans to non-albicans species, particularly Candida glabrata. Recent guidelines recommend echinocandins as first-line therapy for IC, with de-escalation to fluconazole when sensitivities are available and after the patient has become clinically stable. Despite widespread use in clinical practice, the evidence for prophylactic therapy remains weak.
