European surveillance studies show that the incidence of Candida bloodstream infections (BSI) ranges from nearly 3 to 8.6 per 100 000 population per year [ 1 x 1 Marchetti, O, Bille, J, Fluckiger, U et al. Epidemiology of candidemia in Swiss tertiary care hospitals: secular trends, 1991–2000. Clin Infect Dis. 2004; 38: 311–320 Crossref | PubMed | Scopus (340) | Google Scholar See all References , 2 x 2 Poikonen, E, Lyytikainen, O, Anttila, VJ et al. Secular trend in candidemia and the use of fluconazole in Finland, 2004–2007. BMC Infect Dis. 2010; 10: 312 Crossref | PubMed | Scopus (60) | Google Scholar See all References , 3 x 3 Sandven, P, Bevanger, L, Digranes, A, Haukland, HH, Mannsaker, T, and Gaustad, P. Candidemia in Norway (1991 to 2003): results from a nationwide study. J Clin Microbiol. 2006; 44: 1977–1981 Crossref | PubMed | Scopus (133) | Google Scholar See all References , 4 x 4 Arendrup, MC, Bruun, B, Christensen, JJ et al. National surveillance of fungemia in Denmark (2004 to 2009). J Clin Microbiol. 2011; 49: 325–334 Crossref | PubMed | Scopus (147) | Google Scholar See all References , 5 x 5 Asmundsdottir, LR, Erlendsdottir, H, and Gottfredsson, M. Nationwide study of candidemia, antifungal use, and antifungal drug resistance in Iceland, 2000 to 2011. J Clin Microbiol. 2013; 51: 841–848 Crossref | PubMed | Scopus (45) | Google Scholar See all References , 6 x 6 Almirante, B, Rodriguez, D, Park, BJ et al. Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, Barcelona, Spain, from 2002 to 2003. J Clin Microbiol. 2005; 43: 1829–1835 Crossref | PubMed | Scopus (437) | Google Scholar See all References ].

In accordance with the recommendations of, amongst others, the Surviving Sepsis Campaign and the recently published European treatment guidelines for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), in the event of a patient with such infections, empirical antibiotic treatment must be appropriate and administered as early as possible. The aim of this manuscript is to update treatment protocols by reviewing recently published studies on the treatment of nosocomial pneumonia in the critically ill patients that require invasive respiratory support and patients with HAP from hospital wards that require invasive mechanical ventilation. An interdisciplinary group of experts, comprising specialists in anaesthesia and resuscitation and in intensive care medicine, updated the epidemiology and antimicrobial resistance and established clinical management priorities based on patients’ risk factors. Implementation of rapid diagnostic microbiological techniques available and the new antibiotics recently added to the therapeutic arsenal has been reviewed and updated. After analysis of the categories outlined, some recommendations were suggested, and an algorithm to update empirical and targeted treatment in critically ill patients has also been designed. These aspects are key to improve VAP outcomes because of the severity of patients and possible acquisition of multidrug-resistant organisms (MDROs).

Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting, particularly in the intensive care unit (ICU).