NEW global guidelines have been developed to improve the management of Candida infections, addressing emerging antifungal resistance, recent taxonomic reclassifications, and gaps in existing treatment recommendations. Led by the European Confederation for Medical Mycology (ECMM) in collaboration with international mycological societies, these guidelines provide updated diagnostic and therapeutic strategies for both mucocutaneous and invasive candidiasis, incorporating the latest evidence on novel antifungals and infection control measures.
Candida species remain the most common cause of fungal infections in hospitalised patients, contributing significantly to morbidity and mortality. While mucocutaneous forms such as oral thrush and vulvovaginal candidiasis are typically non-life-threatening, invasive candidiasis and candidaemia pose severe risks to immunocompromised and critically ill patients.
The increasing prevalence of difficult-to-treat infections, particularly those caused by Candida auris and fluconazole-resistant Candida parapsilosis, has heightened concerns in healthcare settings. Candida auris is highly transmissible in hospitals and often exhibits multidrug resistance. Recent taxonomic revisions have also reclassified several medically important Candida species, which may lead to diagnostic confusion and impact clinical practice.
The updated guidelines emphasise the continued importance of conventional microscopy and culture-based diagnostics, while recognising the selective value of molecular assays and biomarkers in specific clinical scenarios. Treatment recommendations have been refined in response to growing antifungal resistance. Echinocandins, including the recently introduced rezafungin, are now the preferred first-line treatment for invasive candidiasis and candidaemia, except in cases involving the central nervous system or ocular infections.
Alternative options include liposomal amphotericin B, sometimes combined with flucytosine, and fluconazole where susceptibility allows. For mucocutaneous infections, novel antifungals such as ibrexafungerp and oteseconazole provide expanded therapeutic options. Managing Candida auris outbreaks requires a multipronged approach, including patient screening, isolation, and environmental decontamination to prevent healthcare-associated transmission.
Future challenges include optimising the clinical use of novel antifungals and ensuring effective adaptation of the guidelines based on regional resistance patterns and resource availability.
Ada Enesco, EMJ
Reference
Cornely OA et al. Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM. Lancet Infect Dis. 2025;DOI: 10.1016/S1473-3099(24)00749-7.
