Top

Published in:

Open Access 21-03-2024 | Candidiasis | Conference Reports and Expert Panel

Invasive Fungal Diseases in Adult Patients in Intensive Care Unit (FUNDICU): 2024 consensus definitions from ESGCIP, EFISG, ESICM, ECMM, MSGERC, ISAC, and ISHAM

Authors: Matteo Bassetti, Daniele R. Giacobbe, Christina Agvald-Ohman, Murat Akova, Ana Alastruey-Izquierdo, Sevtap Arikan-Akdagli, Elie Azoulay, Stijn Blot, Oliver A. Cornely, Manuel Cuenca-Estrella, Dylan W. de Lange, Francesco G. De Rosa, Jan J. De Waele, George Dimopoulos, Jose Garnacho-Montero, Martin Hoenigl, Souha S. Kanj, Philipp Koehler, Bart J. Kullberg, Frédéric Lamoth, Cornelia Lass-Flörl, Johan Maertens, Ignacio Martin-Loeches, Patricia Muñoz, Garyphallia Poulakou, Jordi Rello, Maurizio Sanguinetti, Fabio S. Taccone, Jean-François Timsit, Antoni Torres, Jose A. Vazquez, Joost Wauters, Erika Asperges, Andrea Cortegiani, Cecilia Grecchi, Ilias Karaiskos, Clément Le Bihan, Toine Mercier, Klaus L. Mortensen, Maddalena Peghin, Chiara Rebuffi, Sofia Tejada, Antonio Vena, Valentina Zuccaro, Luigia Scudeller, Thierry Calandra, the Study Group for Infections in Critically Ill Patients of the European Society of Clinical Microbiology and Infectious Diseases (ESGCIP), the Fungal Infection Study Group of the European Society of Clinical Microbiology and Infectious Diseases (EFISG), the European Society of Intensive Care Medicine (ESICM), the European Confederation of Medical Mycology (ECMM), the Mycoses Study Group Education and Research Consortium (MSGERC), the International Society of Antimicrobial Chemotherapy (ISAC), the International Society for Human and Animal Mycology (ISHAM), the Austrian Society for Medical Mycology (ÖGMM), the Italian Society of Anesthesia, Analgesia, Reanimation, and Intensive Care (SIAARTI), the Italian Society of Anti-Infective Therapy (SITA), and the FUNDICU Collaborators

Published in: Intensive Care Medicine | Issue 4/2024

Abstract

Purpose

The aim of this document was to develop standardized research definitions of invasive fungal diseases (IFD) in non-neutropenic, adult patients without classical host factors for IFD, admitted to intensive care units (ICUs).

Methods

After a systematic assessment of the diagnostic performance for IFD in the target population of already existing definitions and laboratory tests, consensus definitions were developed by a panel of experts using the RAND/UCLA appropriateness method.

Results

Standardized research definitions were developed for proven invasive candidiasis, probable deep-seated candidiasis, proven invasive aspergillosis, probable invasive pulmonary aspergillosis, and probable tracheobronchial aspergillosis. The limited evidence on the performance of existing definitions and laboratory tests for the diagnosis of IFD other than candidiasis and aspergillosis precluded the development of dedicated definitions, at least pending further data. The standardized definitions provided in the present document are aimed to speed-up the design, and increase the feasibility, of future comparative research studies.

Available only for authorised users

Bassetti M, Bouza E (2017) Invasive mould infections in the ICU setting: complexities and solutions. J Antimicrob Chemother 72(supp_l 1):39–47. https://doi.org/10.1093/jac/dkx032CrossRef

Bassetti M, Giacobbe DR, Vena A et al (2019) Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project. Crit Care 23(1):219. https://doi.org/10.1186/s13054-019-2497-3CrossRefPubMedPubMedCentral

Delaloye J, Calandra T (2014) Invasive candidiasis as a cause of sepsis in the critically ill patient. Virulence 5(1):161–169. https://doi.org/10.4161/viru.26187CrossRefPubMed

Ostrosky-Zeichner L, Al-Obaidi M (2017) Invasive fungal infections in the intensive care unit. Infect Dis Clin N Am 31(3):475–487. https://doi.org/10.1016/j.idc.2017.05.005CrossRef

Taccone FS, Van den Abeele AM, Bulpa P et al (2015) Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes. Crit Care 19:7. https://doi.org/10.1186/s13054-014-0722-7CrossRefPubMedPubMedCentral

Bassetti M, Righi E, Ansaldi F et al (2015) A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality. Intensive Care Med 41(9):1601–1610. https://doi.org/10.1007/s00134-015-3866-2CrossRefPubMed

Kluge S, Strauss R, Kochanek M, Weigand MA, Rohde H, Lahmer T (2021) Aspergillosis: emerging risk groups in critically ill patients. Med Mycol. https://doi.org/10.1093/mmy/myab064CrossRefPubMed

Leroy O, Gangneux JP, Montravers P et al (2009) Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005–2006). Crit Care Med 37(5):1612–1618. https://doi.org/10.1097/CCM.0b013e31819efac0CrossRefPubMed

Prattes J, Wauters J, Giacobbe DR et al (2022) Risk factors and outcome of pulmonary aspergillosis in critically ill coronavirus disease 2019 patients-a multinational observational study by the European Confederation of Medical Mycology. Clin Microbiol Infect 28(4):580–587. https://doi.org/10.1016/j.cmi.2021.08.014CrossRefPubMed

10.

Salmanton-Garcia J, Sprute R, Stemler J et al (2021) COVID-19-associated pulmonary aspergillosis, March–August 2020. Emerg Infect Dis 27(4):1077–1086. https://doi.org/10.3201/eid2704.204895CrossRefPubMedPubMedCentral

11.

Schauwvlieghe A, Rijnders BJA, Philips N et al (2018) Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med 6(10):782–792. https://doi.org/10.1016/S2213-2600(18)30274-1CrossRefPubMed

12.

Janssen NAF, Nyga R, Vanderbeke L et al (2021) Multinational observational cohort study of COVID-19-associated pulmonary aspergillosis (1). Emerg Infect Dis 27(11):2892–2898. https://doi.org/10.3201/eid2711.211174CrossRefPubMedPubMedCentral

13.

Bassetti M, Marchetti M, Chakrabarti A et al (2013) A research agenda on the management of intra-abdominal candidiasis: results from a consensus of multinational experts. Intensive Care Med 39(12):2092–2106. https://doi.org/10.1007/s00134-013-3109-3CrossRefPubMed

14.

Blot SI, Taccone FS, Van den Abeele AM et al (2012) A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am J Respir Crit Care Med 186(1):56–64. https://doi.org/10.1164/rccm.201111-1978OCCrossRefPubMed

15.

Bulpa P, Dive A, Sibille Y (2007) Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease. Eur Respir J 30(4):782–800. https://doi.org/10.1183/09031936.00062206CrossRefPubMed

16.

Koehler P, Bassetti M, Chakrabarti A et al (2021) Defining and managing COVID-19-associated pulmonary Aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis 21(6):e149–e162. https://doi.org/10.1016/S1473-3099(20)30847-1CrossRefPubMed

17.

Vandewoude KH, Blot SI, Depuydt P et al (2006) Clinical relevance of Aspergillus isolation from respiratory tract samples in critically ill patients. Crit Care 10(1):R31. https://doi.org/10.1186/cc4823CrossRefPubMedPubMedCentral

18.

Verweij PE, Bruggemann RJM, Azoulay E et al (2021) Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis. Intensive Care Med 47(8):819–834. https://doi.org/10.1007/s00134-021-06449-4CrossRefPubMedPubMedCentral

19.

Verweij PE, Rijnders BJA, Bruggemann RJM et al (2020) Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion. Intensive Care Med 46(8):1524–1535. https://doi.org/10.1007/s00134-020-06091-6CrossRefPubMedPubMedCentral

20.

Donnelly JP, Chen SC, Kauffman CA et al (2020) Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis 71(6):1367–1376. https://doi.org/10.1093/cid/ciz1008CrossRefPubMed

21.

Bassetti M, Scudeller L, Giacobbe DR et al (2019) Developing definitions for invasive fungal diseases in critically ill adult patients in intensive care units. Protocol of the FUNgal infections Definitions in ICU patients (FUNDICU) project. Mycoses 62(4):310–319. https://doi.org/10.1111/myc.12869CrossRefPubMed

22.

Bassetti M, Giacobbe DR, Grecchi C et al (2020) Performance of existing definitions and tests for the diagnosis of invasive aspergillosis in critically ill, adult patients: a systematic review with qualitative evidence synthesis. J Infect 81(1):131–146. https://doi.org/10.1016/j.jinf.2020.03.065CrossRefPubMed

23.

Giacobbe DR, Cortegiani A, Karaiskos I et al (2021) Performance of existing definitions and tests for the diagnosis of invasive fungal diseases other than invasive candidiasis and invasive aspergillosis in critically ill, adult patients: a systematic review with qualitative evidence synthesis. J Fungi (Basel, Switzerland) 7(3):176. https://doi.org/10.3390/jof7030176CrossRef

24.

Giacobbe DR, Asperges E, Cortegiani A et al (2022) Performance of existing clinical scores and laboratory tests for the diagnosis of invasive candidiasis in critically ill, nonneutropenic, adult patients: a systematic review with qualitative evidence synthesis. Mycoses 65(12):1073–1111. https://doi.org/10.1111/myc.13515CrossRefPubMed

25.

Bassetti M, Zuccaro V, Asperges E, Scudeller L, Giacobbe DR, Investigators F (2022) Performance of existing definitions and tests for the diagnosis of invasive aspergillosis in critically ill, non-neutropenic, adult patients: an update including COVID-19 data. J Infect 85(5):573–607. https://doi.org/10.1016/j.jinf.2022.08.003CrossRefPubMedPubMedCentral

26.

Brook RH, Chassin MR, Fink A, Solomon DH, Kosecoff J, Park RE (1986) A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care 2(1):53–63. https://doi.org/10.1017/s0266462300002774CrossRefPubMed

27.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381. https://doi.org/10.1016/j.jbi.2008.08.010CrossRefPubMed

28.

Williamson PR, Altman DG, Blazeby JM et al (2012) Developing core outcome sets for clinical trials: issues to consider. Trials 13:132. https://doi.org/10.1186/1745-6215-13-132CrossRefPubMedPubMedCentral

29.

Baldesi O, Bailly S, Ruckly S et al (2017) ICU-acquired candidaemia in France: epidemiology and temporal trends, 2004–2013—a study from the REA-RAISIN network. J Infect 75(1):59–67. https://doi.org/10.1016/j.jinf.2017.03.011CrossRefPubMed

30.

Bassetti M, Righi E, Ansaldi F et al (2014) A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality. Intensive Care Med 40(6):839–845. https://doi.org/10.1007/s00134-014-3310-zCrossRefPubMed

31.

Bassetti M, Vena A, Giacobbe DR et al (2022) Risk factors for intra-abdominal candidiasis in intensive care units: results from EUCANDICU study. Infect Dis Ther 11(2):827–840. https://doi.org/10.1007/s40121-021-00585-6CrossRefPubMedPubMedCentral

32.

Bassetti M, Vena A, Meroi M et al (2020) Factors associated with the development of septic shock in patients with candidemia: a post hoc analysis from two prospective cohorts. Crit Care 24(1):117. https://doi.org/10.1186/s13054-020-2793-yCrossRefPubMedPubMedCentral

33.

Kett DH, Azoulay E, Echeverria PM, Vincent JL, Extended Prevalence of Infection in ICUSGoI (2011) Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study. Crit Care Med 39(4):665–670. https://doi.org/10.1097/CCM.0b013e318206c1caCrossRefPubMed

34.

Paiva JA, Pereira JM, Tabah A et al (2016) Characteristics and risk factors for 28-day mortality of hospital acquired fungemias in ICUs: data from the EUROBACT study. Crit Care 20:53. https://doi.org/10.1186/s13054-016-1229-1CrossRefPubMedPubMedCentral

35.

Tortorano AM, Dho G, Prigitano A et al (2012) Invasive fungal infections in the intensive care unit: a multicentre, prospective, observational study in Italy (2006–2008). Mycoses 55(1):73–79. https://doi.org/10.1111/j.1439-0507.2011.02044.xCrossRefPubMed

36.

Vincent JL, Rello J, Marshall J et al (2009) International study of the prevalence and outcomes of infection in intensive care units. JAMA 302(21):2323–2329. https://doi.org/10.1001/jama.2009.1754CrossRefPubMed

37.

Bassetti M, Azoulay E, Kullberg BJ et al (2021) EORTC/MSGERC definitions of invasive fungal diseases: summary of activities of the intensive care unit working group. Clin Infect Dis 72(Suppl 2):S121–S127. https://doi.org/10.1093/cid/ciaa1751CrossRefPubMed

38.

Pappas PG, Lionakis MS, Arendrup MC, Ostrosky-Zeichner L, Kullberg BJ (2018) Invasive candidiasis. Nat Rev Dis Primers 4:18026. https://doi.org/10.1038/nrdp.2018.26CrossRefPubMed

39.

Clancy CJ, Nguyen MH (2013) Finding the “missing 50%” of invasive candidiasis: how nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin Infect Dis 56(9):1284–1292. https://doi.org/10.1093/cid/cit006CrossRefPubMed

40.

Ruhnke M, Bohme A, Buchheidt D et al (2012) Diagnosis of invasive fungal infections in hematology and oncology-guidelines from the Infectious Diseases Working Party in Haematology and Oncology of the German Society for Haematology and Oncology (AGIHO). Ann Oncol 23(4):823–833. https://doi.org/10.1093/annonc/mdr407CrossRefPubMed

41.

De Waele JJ, Boelens J, Van De Putte D, Huis In ’t Veld D, Coenye T (2022) The role of abdominal drain cultures in managing abdominal infections. Antibiotics (Basel). 11(5):97. https://doi.org/10.3390/antibiotics11050697CrossRef

42.

Husain S, Mooney ML, Danziger-Isakov L et al (2011) A 2010 working formulation for the standardization of definitions of infections in cardiothoracic transplant recipients. J Heart Lung Transplant 30(4):361–374. https://doi.org/10.1016/j.healun.2011.01.701CrossRefPubMedPubMedCentral

43.

Maschmeyer G, Haas A, Cornely OA (2007) Invasive aspergillosis: epidemiology, diagnosis and management in immunocompromised patients. Drugs 67(11):1567–1601. https://doi.org/10.2165/00003495-200767110-00004CrossRefPubMed

44.

Baddley JW, Stephens JM, Ji X, Gao X, Schlamm HT, Tarallo M (2013) Aspergillosis in intensive care unit (ICU) patients: epidemiology and economic outcomes. BMC Infect Dis 13:29. https://doi.org/10.1186/1471-2334-13-29CrossRefPubMedPubMedCentral

45.

Meersseman W, Vandecasteele SJ, Wilmer A, Verbeken E, Peetermans WE, Van Wijngaerden E (2004) Invasive aspergillosis in critically ill patients without malignancy. Am J Respir Crit Care Med 170(6):621–625. https://doi.org/10.1164/rccm.200401-093OCCrossRefPubMed

46.

Prattes J, Wauters J, Giacobbe DR, Lagrou K, Hoenigl M, Group E-CS (2021) Diagnosis and treatment of COVID-19 associated pulmonary apergillosis in critically ill patients: results from a European confederation of medical mycology registry. Intensive Care Med 47(10):1158–1160. https://doi.org/10.1007/s00134-021-06471-6CrossRefPubMedPubMedCentral

47.

van de Veerdonk FL, Kolwijck E, Lestrade PP et al (2017) Influenza-associated aspergillosis in critically ill patients. Am J Respir Crit Care Med 196(4):524–527. https://doi.org/10.1164/rccm.201612-2540LECrossRefPubMed

48.

Bartoletti M, Pascale R, Cricca M et al (2021) Epidemiology of invasive pulmonary aspergillosis among intubated patients with COVID-19: a prospective study. Clin Infect Dis 73(11):e3606–e3614. https://doi.org/10.1093/cid/ciaa1065CrossRefPubMed

49.

Borman AM, Palmer MD, Fraser M et al (2020) COVID-19-associated invasive aspergillosis: data from the UK National Mycology Reference Laboratory. J Clin Microbiol. https://doi.org/10.1128/JCM.02136-20CrossRefPubMedPubMedCentral

50.

Lahmer T, Kriescher S, Herner A et al (2021) Invasive pulmonary aspergillosis in critically ill patients with severe COVID-19 pneumonia: results from the prospective AspCOVID-19 study. PLoS ONE 16(3):e0238825. https://doi.org/10.1371/journal.pone.0238825CrossRefPubMedPubMedCentral

51.

Nyga R, Maizel J, Nseir S et al (2020) Invasive tracheobronchial aspergillosis in critically ill patients with severe influenza. A clinical trial. Am J Respir Crit Care Med 202(5):708–716. https://doi.org/10.1164/rccm.201910-1931OCCrossRefPubMed

52.

Permpalung N, Chiang TP, Massie AB et al (2022) Coronavirus disease 2019-associated pulmonary aspergillosis in mechanically ventilated patients. Clin Infect Dis 74(1):83–91. https://doi.org/10.1093/cid/ciab223CrossRefPubMed

53.

van de Veerdonk FL, Wauters J, Verweij PE (2020) Invasive aspergillus tracheobronchitis emerging as a highly lethal complication of severe influenza. Am J Respir Crit Care Med 202(5):646–648. https://doi.org/10.1164/rccm.202005-1883EDCrossRefPubMedPubMedCentral

54.

Ergun M, Bruggemann RJM, Alanio A et al (2021) Aspergillus test profiles and mortality in critically ill COVID-19 patients. J Clin Microbiol 59(12):e0122921. https://doi.org/10.1128/JCM.01229-21CrossRefPubMed

55.

Giacobbe DR, Prattes J, Wauters J et al (2022) Prognostic impact of bronchoalveolar lavage fluid galactomannan and aspergillus culture results on survival in COVID-19 intensive care unit patients: a post hoc analysis from the European Confederation of Medical Mycology (ECMM) COVID-19-associated pulmonary aspergillosis study. J Clin Microbiol 60(4):e0229821. https://doi.org/10.1128/jcm.02298-21CrossRefPubMed

56.

Di Meco G, Mora S, Giacobbe DR et al (2022) A wide database for a multicenter study on Pneumocystis jirovecii pneumonia in intensive care units. Stud Health Technol Inform 294:557–558. https://doi.org/10.3233/SHTI220521CrossRefPubMed

57.

Giacobbe DR, Dettori S, Di Pilato V et al (2023) Pneumocystis jirovecii pneumonia in intensive care units: a multicenter study by ESGCIP and EFISG. Crit Care 27(1):323. https://doi.org/10.1186/s13054-023-04608-1CrossRefPubMedPubMedCentral

Title: Invasive Fungal Diseases in Adult Patients in Intensive Care Unit (FUNDICU): 2024 consensus definitions from ESGCIP, EFISG, ESICM, ECMM, MSGERC, ISAC, and ISHAM
Authors: Matteo Bassetti
Daniele R. Giacobbe
Christina Agvald-Ohman
Murat Akova
Ana Alastruey-Izquierdo
Sevtap Arikan-Akdagli
Elie Azoulay
Stijn Blot
Oliver A. Cornely
Manuel Cuenca-Estrella
Dylan W. de Lange
Francesco G. De Rosa
Jan J. De Waele
George Dimopoulos
Jose Garnacho-Montero
Martin Hoenigl
Souha S. Kanj
Philipp Koehler
Bart J. Kullberg
Frédéric Lamoth
Cornelia Lass-Flörl
Johan Maertens
Ignacio Martin-Loeches
Patricia Muñoz
Garyphallia Poulakou
Jordi Rello
Maurizio Sanguinetti
Fabio S. Taccone
Jean-François Timsit
Antoni Torres
Jose A. Vazquez
Joost Wauters
Erika Asperges
Andrea Cortegiani
Cecilia Grecchi
Ilias Karaiskos
Clément Le Bihan
Toine Mercier
Klaus L. Mortensen
Maddalena Peghin
Chiara Rebuffi
Sofia Tejada
Antonio Vena
Valentina Zuccaro
Luigia Scudeller
Thierry Calandra
the Study Group for Infections in Critically Ill Patients of the European Society of Clinical Microbiology and Infectious Diseases (ESGCIP), the Fungal Infection Study Group of the European Society of Clinical Microbiology and Infectious Diseases (EFISG), the European Society of Intensive Care Medicine (ESICM), the European Confederation of Medical Mycology (ECMM), the Mycoses Study Group Education and Research Consortium (MSGERC), the International Society of Antimicrobial Chemotherapy (ISAC), the International Society for Human and Animal Mycology (ISHAM), the Austrian Society for Medical Mycology (ÖGMM), the Italian Society of Anesthesia, Analgesia, Reanimation, and Intensive Care (SIAARTI), the Italian Society of Anti-Infective Therapy (SITA), and the FUNDICU Collaborators
Publication date: 21-03-2024
Publisher: Springer Berlin Heidelberg
Keywords: Candidiasis
Candidiasis
Invasive Aspergillosis
Aspergillosis
Published in: Intensive Care Medicine / Issue 4/2024
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-024-07341-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Invasive Fungal Diseases in Adult Patients in Intensive Care Unit (FUNDICU): 2024 consensus definitions from ESGCIP, EFISG, ESICM, ECMM, MSGERC, ISAC, and ISHAM

Abstract

Purpose

Methods

Results

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Please log in to get access to this content

Other articles of this Issue 4/2024

Bedside-available strategies to minimise P-SILI and VILI during ARDS

Measuring patient’s effort on the ventilator

Knowing the ropes of vasopressor dosing: a focus on norepinephrine

Long-term survival and functional outcomes of critically ill patients with hematologic malignancies: a Canadian multicenter prospective study

Memories of ICU stay in patients admitted for severe COVID-19

Correction: Phase-3 trial of recombinant human alkaline phosphatase for patients with sepsis-associated acute kidney injury (REVIVAL)