What is the role of empirical treatment for suspected invasive candidiasis in non-neutropenic non transplanted patients in the intensive care unit?—Empiricus strikes back!

In its last guidelines, published in the early 2016, the Infectious Diseases Society of America (IDSA), sought to answer that difficult question relative to intensive care unit (ICU) patients (1) and stated that: (I) empirical antifungal therapy should be considered in critically ill patients with risk factors for invasive candidiasis and no other known cause of fever and should be based on clinical assessment of risk factors, surrogate markers for invasive candidiasis, and/or culture data from non-sterile sites; (II) empirical antifungal therapy should be started as soon as possible in patients who have the above risk factors and who have clinical signs of septic shock; (III) in such a situation, an echinocandin should be the preferred treatment. For these three items, and despite moderate quality of evidence, the strength of the recommendations was strong.