Invasive fungal infections are becoming more common in intensive care, where Candida and Aspergillus species are the most important pathogens and Candida alone accounts for around 80% of cases. Diagnosis and treatment are growing harder as antifungal resistance rises and rarer species emerge, and candidaemia still carries a mortality of between 28 and 59%. Practice varies widely between countries and specialties.
To map where clinicians agree on the remaining challenges, a multidisciplinary Western European expert panel developed 44 statements across six domains, from raising clinical suspicion to managing drug interactions. The statements were tested through a modified Delphi consensus, with an online survey completed by 335 healthcare professionals, including intensivists, infectious disease specialists, microbiologists and pharmacists across France, Germany, Italy, Spain and the UK. Agreement was pre-specified at 75%.
Forty of the 44 statements reached consensus, 29 of them at very high agreement of 90% or above. The recommendations were practical: clinicians should know the local incidence of infection and azole resistance in their unit, treatment should begin immediately where clinical suspicion is high rather than waiting for test results, and beta-D-glucan testing should be available in every ICU with results within 48 hours.
Triducive was the independent facilitator for this modified Delphi consensus, managing the process and survey to keep responses anonymous, and providing medical writing support. The consensus offers a shared path towards more consistent management of invasive fungal infection in the ICU.
Hoenigl M, et al. Mycopathologia, 2024; 189(3): 41. DOI: 10.1007/s11046-024-00852-3
