title: Fungal infections in the ICU: advances in treatment and diagnosis.
abstract: OBJECTIVE
  The aim of this review is to give an update on the available diagnostic approaches and currently adopted therapeutic management of severe fungal diseases in the ICU setting.
  
  
  RESULTS
  In order to reduce the clinical impact of life-threatening Candida infections, prompt diagnosis and appropriate treatment are strictly required. Preemptive strategies, mainly based on serological markers [i.e., (1-3)-β-D-glucan assay] are progressively replacing prophylactic and empirical approaches, limiting inadequate antifungal use. For the diagnosis of aspergillosis new algorithm has been recently validated, supported by the better knowledge of galactomannan antigen kinetic as a clinical marker. Echinocandins and voriconazole are the first choice drugs for the treatment of invasive Candida and Aspergillus infections, respectively. Although rare, other fungal infections (i.e., Pneumocystis jirovecii, Cryptococcus spp., and Mucorales spp.) may be responsible for life-threatening diseases in ICU patients, and early diagnosis and appropriate treatment are also important.
  
  
  CONCLUSIONS
  Critically ill patients may frequently experience severe invasive fungal infections. Biomarkers-based diagnostic approaches give, at the same time, the possibility to early detect the ongoing infection and reduce inappropriate antifungal therapy in nonconfirmed cases. Potent and well tolerated drugs are now available for the treatment of proven cases but clinicians should carefully consider the risk of treatment failure and the availability of new monitoring and therapeutic tools.
authors.affiliation: aDepartment of Intensive Care and Anesthesiology bInstitute of Infectious Diseases, Università Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: De Pascale
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control; D001230:Aspergillus / Q000472:pathogenicity; D015415:Biomarkers; D002175:Candida / Q000472:pathogenicity; D058365:Candidiasis, Invasive / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control; D002986:Clinical Trials as Topic; D003422:Critical Care / Q000379:methods / Q000458:organization & administration*; D016638:Critical Illness; D017408:Guidelines as Topic; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D008172:Lung Diseases, Fungal / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents; D015415:Biomarkers