title: MEDical wards Invasive Candidiasis ALgorithms (MEDICAL):Consensus proposal for management.
abstract: BACKGROUND
  A majority of invasive Candida infections occur in medical wards; however, evidence for management in this setting is scarce and based primarily on the intensive care or surgical setting. On behalf of the Italian Society for Anti-Infective Therapy (SITA) and the Italian Federation of Associations of Hospital Doctors on Internal Medicine (FADOI), the MEDICAL group produced practical management algorithms for patients in internal medicine wards.
  
  
  METHODS
  The MEDICAL group panel, composed of 30 members from internal medicine, infectious disease, clinical pharmacology, clinical microbiology and clinical epidemiology, provided expert opinion through the RAND/UCLA method.
  
  
  RESULTS
  Seven clinical scenarios were constructed based on clinical severity and probability of invasive candidiasis. For each scenario, the appropriateness of 63 different diagnostic, imaging, management, or therapeutic procedures was determined in two Delphi rounds. The necessity for performing each appropriate procedure, was then determined in a third Delphi round. Results were summarized in algorithms.
  
  
  CONCLUSIONS
  The proposed algorithms provide internal medicine physicians and managers with an easy to interpret tool that is exhaustive, clear and suitable for adaption to individual local settings. Attention was paid to individual patient management and resource allocation.
authors: Clinical Epidemiology Unit, Scientific Direction, IRCCS, Policlinico San Matteo Foundation, Pavia, Italy. Electronic address: l.scudeller@smatteo.pv.it.
authors: Luigia
authors: L
authors: Scudeller
authors: Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy.
authors: Matteo
authors: M
authors: Bassetti
authors: Section of Infectious Diseases, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Policlinico G B Rossi, Verona, Italy.
authors: Ercole
authors: E
authors: Concia
authors: Department of Internal Medicine, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Di.Bi.M.I.S., University of Palermo, Italy.
authors: Salvatore
authors: S
authors: Corrao
authors: Infectious Diseases Unit, Teaching Hospital Policlinico S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors: Francesco
authors: F
authors: Cristini
authors: Department of Medical Sciences, University of Torino, Torino, Italy.
authors: Francesco Giuseppe
authors: FG
authors: De Rosa
authors: Clinic of Infectious Diseases, IRCCS San Martino-IST, University of Genova, Genova, Italy.
authors: Valerio
authors: V
authors: Del Bono
authors: Internal Medicine Section, Department of Cardiothoracic Sciences, and Division of Infectious and Transplant Medicine, Second University of Naples at Monaldi Hospital, Napoli, Italy.
authors: Emanuele
authors: E
authors: Durante-Mangoni
authors: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
authors: Marco
authors: M
authors: Falcone
authors: Infectious Disease Department, Cisanello Hospital, Pisa, Italy.
authors: Francesco
authors: F
authors: Menichetti
authors: Infectious Disease Department, Cisanello Hospital, Pisa, Italy.
authors: Carlo
authors: C
authors: Tascini
authors: Infectious Diseases Institute, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors: Mario
authors: M
authors: Tumbarello
authors: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
authors: Mario
authors: M
authors: Venditti
authors: Infectious Diseases Unit, Teaching Hospital Policlinico S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors: Pierluigi
authors: P
authors: Viale
authors: Clinic of Infectious Diseases, IRCCS San Martino-IST, University of Genova, Genova, Italy.
authors: Claudio
authors: C
authors: Viscoli
authors: Internal Medicine Department, Hospital of Legnano, Legnano, Italy.
authors: Antonino
authors: A
authors: Mazzone
mesh_terms: D000465:Algorithms; D000935:Antifungal Agents / Q000627:therapeutic use*; D058365:Candidiasis, Invasive / Q000175:diagnosis* / Q000188:drug therapy*; D003422:Critical Care / Q000379:methods*; D003697:Delphi Technique; D042241:Early Diagnosis; D054714:Echinocandins / Q000627:therapeutic use*; D006801:Humans; D007388:Internal Medicine; D007558:Italy; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins
keywords: Clinical severity; Invasive candidiasis; Medical wards; Risk stratification