From the Guidelines
Fungal infections, particularly those caused by Candida species, are a major cause of morbidity and mortality in healthcare environments, and their management should prioritize evidence-based guidelines. The management of fungal infections, including those caused by different species, is crucial for reducing morbidity and mortality. According to the clinical practice guideline for the management of candidiasis updated in 2016 by the Infectious Diseases Society of America 1, invasive infection due to Candida species is a significant concern. The guideline highlights that >90% of invasive disease is caused by the 5 most common pathogens: C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, and C. krusei.
Key considerations in managing fungal infections include:
- Understanding the unique virulence potential, antifungal susceptibility, and epidemiology of each Candida species
- Recognizing the importance of preventing invasive candidiasis, especially in high-risk patients such as those with neutropenia or undergoing hematopoietic stem cell transplantation
- Implementing targeted prophylaxis strategies based on local epidemiology, as recommended in the 2018 guideline strategies for the use of antifungal agents in patients with hematological malignancies or hematopoietic stem cell transplantation recipients in Taiwan 1
- Being aware of the changing epidemiology of fungal infections, with Aspergillus species replacing Candida species as the most common fungal pathogen in some settings
The use of evidence-based guidelines, such as those provided by the Infectious Diseases Society of America 1 and the 2018 guideline strategies for antifungal agents 1, is crucial for determining the best approach to managing fungal infections and reducing morbidity and mortality. These guidelines emphasize the importance of individualized approaches, considering the heterogeneity of patient populations and local epidemiology. By prioritizing these evidence-based recommendations, healthcare providers can improve outcomes for patients at risk of fungal infections.
From the Research
Fungal Infections
- Fungal infections are a growing concern, with an increasing incidence due to a rising population of immunocompromised individuals 2
- Superficial and subcutaneous fungal infections affect the skin, keratinous tissues, and mucous membranes, and are often easily diagnosed and treated 2
- Systemic fungal infections can be life-threatening and are associated with high morbidity and mortality, with Candida albicans and Aspergillus spp. being the most frequently encountered pathogens 2
Treatment of Fungal Infections
- Various antifungal agents are available for the treatment of fungal infections, including terbinafine, itraconazole, fluconazole, and voriconazole 3, 4, 5, 6
- The efficacy of these agents can vary depending on the type of fungal infection and the specific strain of the fungus 4, 6
- Terbinafine and itraconazole are commonly used to treat onychomycosis and superficial dermatomycoses, but poor response to oral terbinafine has been reported 3
- Voriconazole is a broad-spectrum triazole derivative that has been shown to be effective in the treatment of invasive aspergillosis and rare fungal infections 5
Specific Antifungal Agents
- Terbinafine has been shown to be effective in the treatment of Vulvovaginal candidiasis, but may not be suitable as a first-line treatment 6
- Itraconazole and voriconazole have been shown to be effective in the treatment of onychomycosis and superficial fungal infections 3, 4
- Fluconazole has been shown to be effective in the treatment of Vulvovaginal candidiasis, but may not be suitable for the treatment of all types of fungal infections 6
- Posaconazole, fosravuconazole, and oteseconazole are newer antifungal agents that have been shown to be effective in the treatment of onychomycosis and superficial fungal infections, but are not yet US FDA approved for this indication 3