2025 global Candida guidelines¹

What are the 2025 global Candida guidelines?

The 2025 global Candida guidelines provide comprehensive recommendations on the diagnosis, treatment and management of Candida infections.

Epidemiology

• Candida species are the predominant cause of fungal infections – over 1.5 million cases of invasive candidiasis are reported annually
• Candidemia is the most common presentation of invasive candidiasis, with most cases being healthcare-associated
   

Diagnosis

• Conventional methods: Culture and direct microscopy are strongly recommended for diagnosing Candida infections. Chromogenic agars should be used for detecting mixed yeast infections and for screening by culture
• Molecular techniques: Moderately supported in combination with biomarkers or in the absence of alternative methods (e.g. matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry), especially when rapid identification of problematic species is needed. Commercial assays (e.g. T2Candida®) are preferred over in-house assays
• Biomarkers: 1,3-β-D-glucan (BDG) testing and mannan/anti-mannan assays have moderate support but should not be used alone for diagnosis. Biomarkers are recommended for use in conjunction with clinical parameters, other biomarkers or other diagnostic methods
• Antifungal susceptibility testing: Strongly recommended for all invasive infections and mucocutaneous infections not responsive to therapy

Treatment

• Candidemia: Echinocandins are recommended for first-line therapy for candidaemia and all forms of invasive candidiasis except for CNS and ocular infections due to their broad activity and safety profile *, with polyenes and azoles as alternatives depending on resistance. Polyenes are strongly recommended as second-line therapy for cases with suspected resistance, treatment failure or intolerance
• Prophylaxis: Recommendations vary by patient group (e.g. patients with neutropenia, those undergoing abdominal surgery and patients undergoing allogeneic haematopoietic stem cell transplant). Azoles are commonly considered the first-choice agent for prophylaxis. Refer to the full guidelines for population-specific details
• Fever-driven treatment: Not recommended when fever is the sole symptom, but moderately recommended for patients with septic shock or with deteriorating health and additional risk factors of candidemia
• Diagnostic- and biomarker-driven approaches: Insufficient evidence for initiating treatment, but BDG testing may help guide the discontinuation of empirical antifungals

* Refer to the full guidelines for details regarding the management of central nervous system infections, ocular candidiasis, endocarditis and other forms of invasive candidiasis

Other considerations

• Management of Candia auris and other difficult-to-treat pathogens: A multipronged, multidisciplinary approach is recommended, which includes screening of high-risk and close-contact individuals, patient isolation and cleaning of healthcare facilities
• Antifungal stewardship: Recommended for improving guideline adherence and appropriate antifungal use
• Source control: Strongly recommended for all forms of invasive candidiasis, which can include the early removal of central venous catheters in patients with candidemia
• Therapeutic drug monitoring: Should be considered for triazoles and echinocandins in patients at risk of extremely high or low drug exposures and those experiencing treatment failure
  Adapting these guidelines to local contexts based on economic circumstances and resistance patterns is essential for improving patient outcomes.