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Review Open Access

Management of invasive candidiasis in the ICU: Challenges and advances (Review)

  • Authors:
    • Wael Ghaly Elmasry
    • Ahmed Mohamed Abdelbaky
    • Ahmed Hossameldin Ahmed Awad
  • View Affiliations / Copyright

    Affiliations: Department of Anesthesia, Mohammed Bin Rashid University of Medicine and Health Sciences and Intensive Care Unit, Rashid Hospital, Dubai, P.O. Box 4545, United Arab Emirates, Department of Critical Care Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences and Intensive Care Unit, Rashid Hospital, Dubai, P.O. Box 4545, United Arab Emirates
    Copyright: © Ghaly Elmasry et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 79
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    Published online on: October 24, 2025
       https://doi.org/10.3892/mi.2025.278
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Abstract

Invasive candidiasis (IC) is one of the principal causes of morbidity and mortality in critically ill patients, particularly in intensive care units (ICUs). Early diagnosis and prompt treatment are vital for achieving optimal outcomes for patients; however, factors such as delayed diagnosis, antifungal resistance and difficulty in managing critically ill patients make this difficult. The present review describes some of the major challenges involved in the management of IC in ICU settings, including delays in diagnosis, outbreaks of multi‑drug‑resistant Candida species and high mortality rates. Improvements in innovative diagnostic methods, including rapid molecular testing, as well as developments in antifungal therapy, such as rezafungin and ibrexafungerp, help improve patient outcomes. In addition, antifungal stewardship, prevention and combination therapy enhance the management of this complex infection. The present review also discusses clinical guidelines emphasizing the need for early empirical therapy, species‑specific definitive treatment, and proper treatment duration. Continuous research toward new diagnostic procedures, antifungal agents and vaccines is essential to overcoming the challenges posed by IC in critically ill patients.
View Figures

Figure 1

Pathogenesis of invasive candidiasis.
Schematic flowchart illustrating the sequence from the initial
colonization of mucosal surfaces and skin, through the disruption
of host defenses (e.g., broad-spectrum antibiotics,
immunosuppression, total parenteral nutrition), adhesion and
biofilm formation on indwelling devices (central venous catheters),
yeast-to-hyphae morphogenesis with the secretion of hydrolytic
enzymes (secreted aspartyl proteases and phospholipases), mucosal
invasion and translocation into the bloodstream (candidemia),
hematogenous dissemination to distant organs (liver, spleen,
kidneys and brain), immune evasion mechanisms (antigenic variation,
oxidative stress resistance, modulation of host response), and the
resulting clinical outcomes including sepsis, multi-organ failure,
and high mortality rates in intensive care units.
View References

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Spandidos Publications style
Ghaly Elmasry W, Mohamed Abdelbaky A and Ahmed Awad A: Management of invasive candidiasis in the ICU: Challenges and advances (Review). Med Int 5: 79, 2025.
APA
Ghaly Elmasry, W., Mohamed Abdelbaky, A., & Ahmed Awad, A. (2025). Management of invasive candidiasis in the ICU: Challenges and advances (Review). Medicine International, 5, 79. https://doi.org/10.3892/mi.2025.278
MLA
Ghaly Elmasry, W., Mohamed Abdelbaky, A., Ahmed Awad, A."Management of invasive candidiasis in the ICU: Challenges and advances (Review)". Medicine International 5.6 (2025): 79.
Chicago
Ghaly Elmasry, W., Mohamed Abdelbaky, A., Ahmed Awad, A."Management of invasive candidiasis in the ICU: Challenges and advances (Review)". Medicine International 5, no. 6 (2025): 79. https://doi.org/10.3892/mi.2025.278
Copy and paste a formatted citation
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Spandidos Publications style
Ghaly Elmasry W, Mohamed Abdelbaky A and Ahmed Awad A: Management of invasive candidiasis in the ICU: Challenges and advances (Review). Med Int 5: 79, 2025.
APA
Ghaly Elmasry, W., Mohamed Abdelbaky, A., & Ahmed Awad, A. (2025). Management of invasive candidiasis in the ICU: Challenges and advances (Review). Medicine International, 5, 79. https://doi.org/10.3892/mi.2025.278
MLA
Ghaly Elmasry, W., Mohamed Abdelbaky, A., Ahmed Awad, A."Management of invasive candidiasis in the ICU: Challenges and advances (Review)". Medicine International 5.6 (2025): 79.
Chicago
Ghaly Elmasry, W., Mohamed Abdelbaky, A., Ahmed Awad, A."Management of invasive candidiasis in the ICU: Challenges and advances (Review)". Medicine International 5, no. 6 (2025): 79. https://doi.org/10.3892/mi.2025.278
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