For a study, it was determined that invasive candidiasis was linked to a significant mortality rate (35% to 60%), which was equivalent to that of septic shock. Candidaemia, which was widespread in immunocompromised individuals, and nonacademic systemic candidiasis, which accounts for the majority of infections in critically sick patients, were the two most common kinds. They were, however, difficult to confirm, and a definitive diagnosis was frequently made late in the course of the disease, resulting in a poor prognosis. Researchers offered a practical 2-step technique to enhance the selection of patients sensitive to benefit from empirical antifungal therapy, taking advantage of the strong negative predictive value of risk-assessment strategies and the early rise in certain fungal biomarkers in high-risk patients.

Early empirical treatment improved prognosis and relied on the positive predictive value (PPV) of risk-assessment strategies based on combinations of risk factors (colonization index, Candida score, predictive rules), but it might have also contributed to the overuse of antifungal agents in critically ill patients. Non–culture-based diagnostic approaches, such as specific and nonspecific biomarkers, were likely to enhance the diagnosis of invasive candidiasis in that scenario. Despite early positives in patients with candidemia, Candida DNA and mannan antigen/anti mannan antibodies were of little importance for the diagnosis of invasive candidiasis because they failed to identify noncandidemic systemic candidiasis. The efficacy of 1,3-beta-D-glucan (-D-glucan), a pan fungal cell wall antigen, in the identification of fungal infections in immunocompromised individuals, has been proven. According to preliminary findings, it was also detected early in critically sick individuals with noncandidemic systemic candidiasis.

Reference:journals.lww.com/clinpulm/Abstract/2015/11000/The_Role_of_Biomarkers_for_Starting_Antifungals_in.4.aspx