ICU · Antimicrobial Stewardship

Fungal infections in the ICU: candidaemia and aspergillosis

Also known as Candidaemia · Invasive candidiasis · Invasive pulmonary aspergillosis · Echinocandin · Voriconazole · Candida score · Candida auris · Galactomannan · Beta-D-glucan

Fungal infections in ICU: candidaemia (most common fungal bloodstream infection — ANZ surveillance: Candida albicans 44.4 percent, C. glabrata complex 26.7 percent, C. parapsilosis complex 16.5 percent; C. auris emerging multidrug-resistant) and invasive pulmonary aspergillosis (risk profile broadened to COPD, cirrhosis, influenza and COVID-19). Candida score (Leon 2006, cut-off over 2.5): severe sepsis, multifocal colonisation, TPN, surgery. Diagnosis: blood cultures (median time-to-positivity 22.7 to 42.0 h), beta-D-glucan (cutoff 80 pg/mL: sensitivity 64.4 percent, specificity 92.4 percent), T2Candida. Treatment: echinocandin first-line (caspofungin 70 mg load then 50 mg daily, micafungin 100 mg daily, anidulafungin 200 mg load then 100 mg daily), step down to fluconazole 800 mg load then 400 mg daily after about 5-10 days when stable and susceptible, treat at least 14 days after the last positive culture. Ophthalmology review (ocular candidiasis 10.7 percent). Aspergillosis: voriconazole first-line with therapeutic drug monitoring (target trough 1.0-5.5 mg/L). Mucorales: galactomannan and beta-D-glucan negative — liposomal amphotericin B 5-6 mg/kg/day plus surgery.

Checked against its sources on 2 Sept 2026