Esposito Mathieu, Lemery Florent, Agrinier Nelly, Soudant Marc, Charmillon Alexandre, Degand Nicolas, Dorin Joséphine, Dellamonica Jean, Morand Lucas, Roger Claire, Scala-Bertola Julien, Leone Marc, Novy Emmanuel
Service d'anesthésie-Réanimation Et Médecine Péri-Opératoire Brabois Adulte, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France.
Inserm INSPIIRE, Université de Lorraine, 54000, Nancy, France.
Eur J Clin Microbiol Infect Dis. 2025 May 22. doi: 10.1007/s10096-025-05169-7.
Invasive candidiasis (IC) is a major challenge in intensive care units (ICUs) given its high prevalence, mortality rate, and diagnostic complexity. This national survey aimed to evaluate the knowledge of French intensive care specialists, assess the available resources for IC management, and analyze current bedside practices in ICUs.
A cross-sectional survey was conducted among senior ICU physicians from 221 French ICUs. A structured questionnaire addressing organizational, diagnostic, and therapeutic approaches to IC management, including clinical cases, was distributed, achieving a participation rate of 54.7%.
Of the 121 respondents, 75 provided complete data. Most respondents were experienced intensivists working in public centers and managing hematological oncology patients. Although 65 (74%) respondents reported organizing multidisciplinary staff meeting, mycologists were rarely involved. Despite the availability of rapid diagnostic tools such as serum (1,3)-β-D-glucan (BDG), which was accessible to 63 (75%) respondents, integrating them into patient management at the bedside remains challenging. Additionally, 55 (67%) respondents had access to antifungal therapeutic drug monitoring (TDM), with voriconazole being the most frequently monitored antifungal drug. However, only 5 (9.1%) respondents had access to TDM every day of the week.
This survey highlights the strengths of multidisciplinary teams, TDM and rapid diagnostic tools for managing IC. However, significant gaps remain in their practical application, particularly the integration of diagnostic tools into clinical algorithms to guide bedside decision-making. Optimizing antifungal stewardship through coordinated interventions is essential for accelerating the diagnosis of IC, improving clinical outcomes, reducing resistance and adverse events.
侵袭性念珠菌病（IC）在重症监护病房（ICU）中是一项重大挑战，因其患病率高、死亡率高且诊断复杂。这项全国性调查旨在评估法国重症监护专家的知识水平，评估IC管理的可用资源，并分析ICU当前的床边实践。
对来自221个法国ICU的高级ICU医生进行了横断面调查。分发了一份关于IC管理的组织、诊断和治疗方法（包括临床病例）的结构化问卷，参与率为54.7%。
在121名受访者中，75人提供了完整数据。大多数受访者是在公共中心工作且管理血液肿瘤患者的经验丰富的重症监护医生。尽管65名（74%）受访者报告组织了多学科工作人员会议，但真菌学家很少参与。尽管有快速诊断工具，如血清（1,3）-β-D-葡聚糖（BDG），63名（75%）受访者可以使用，但将它们整合到床边患者管理中仍然具有挑战性。此外，55名（67%）受访者可以进行抗真菌治疗药物监测（TDM），伏立康唑是最常监测的抗真菌药物。然而，只有5名（9.1%）受访者每周每天都可以进行TDM。
这项调查突出了多学科团队、TDM和快速诊断工具在管理IC方面的优势。然而，在其实际应用中仍存在重大差距，特别是将诊断工具整合到临床算法中以指导床边决策。通过协调干预优化抗真菌管理对于加速IC诊断、改善临床结果、降低耐药性和不良事件至关重要。
