• R-A O'Leary, S Einav, M Leone, K Madách, C Martin, and I Martin-Loeches.
• Multidisciplinary Intensive Care, St James's University Hospital, Department of Clinical Medicine, Trinity College, Wellcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland.
• J. Hosp. Infect. 2018 Apr 1; 98 (4): 382-390.

ObjectiveThe global burden of invasive fungal disease is increasing. Candida albicans remains the leading cause of fungal bloodstream infections, although non-albicans candidal infections are emerging. Areas of controversy regarding diagnosis and management are hampering our ability to respond effectively to this evolving threat. The purpose of this narrative review is to address current controversies and provide recommendations to supplement guidelines.Diagnosis Of Invasive CandidiasisDiagnosis of invasive candidiasis requires a combination of diagnostic tests and patient risk factors. Beta-D glucan and Candida albicans germ tube antibody are both used as biomarkers as adjuncts to diagnosis, although direct culture remains the gold standard. Scoring systems are available to help distinguish between colonization and invasive disease.Treatment Of Invasive CandidiasisEchinocandins are recommended as first-line therapy in candidaemia, with de-escalation to fluconazole when clinical stability is achieved. Empirical therapy is highly recommended in high-risk patients, but a more targeted pre-emptive approach is now being favoured. The evidence for prophylactic therapy remains weak.SummaryMortality attributable to invasive candidiasis may be as high as 70%. Prompt diagnosis and treatment, in conjunction with source control, are the key to improving outcomes.Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

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