Clinical practice guidelines for the management of invasive Candida infections in adults in the Middle East region: Expert panel recommendations

Abstract

Invasive Candida infections contribute to significant morbidity and mortality in patients with healthcare-associated infections. They represent a major burden on the public health system, and are challenging to diagnose and treat. A multidisciplinary expert panel critically reviewed available evidence to provide consensus recommendations for the management of invasive Candida infections in the Middle East. Based on diagnosis, recommendations were provided for the management of Candida infections in non-neutropenic and neutropenic patients. Polyenes (amphotericin B-deoxycholate [AmB-d] and lipid formulations amphotericin B [LFAmB]), triazoles (fluconazole, itraconazole and voriconazole), echinocandins (caspofungin, anidulafungin, and micafungin) and flucytosine are the recommended categories of antifungal agents for treatment of Candida infections. Echinocandins are preferred for treatment of proven and suspected Candida infections, especially in critically ill patients or those with previous exposure to azoles. Recommendations were also provided for infections caused by specific Candida species as well as management of different disease conditions. The experts highlighted that the guidelines should be used along with clinical judgment. Given the paucity of published data from the region, research in the form of randomized clinical trials should be given priority.

Keywords: ABCD; ABLC; AMMI; AmB; AmB deoxycholate; AmB-d; Association of Medical Microbiology and Infectious Disease; BSI; C. albicans germ-tube antibodies; CAGTA; Candida; Candidiasis; ECCMID; ECIL4; EORTC/MSG; European Congress of Clinical Microbiology and Infectious Diseases; European Council on Infections in Leukaemia; European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group; Guidelines; ICU; IDSA; Infectious Disease Society of America; L-AmB; LFAmB; Middle East; Treatment; amphotericin B; amphotericin B colloidal dispersion; amphotericin B lipid complex; blood stream infection; intensive care unit; lipid formulation AmB; liposomal AmB.