Brazilian guidelines for the diagnosis and treatment of candidemia and invasive candidiasis in adults and children.

BACKGROUND

Invasive candidiasis, including candidemia and deep-seated Candida infections, remains a major cause of morbidity and mortality in hospitalized patients worldwide, particularly in low- and middle-income countries. In Brazil, candidemia is associated with persistently high mortality rates, driven by late diagnosis, limited access to antifungal agents, and heterogeneous diagnostic capacity. The last national guideline issued by the Brazilian Society of Infectious Diseases (SBI) was published in 2013, and substantial advances have occurred since then in epidemiology, diagnostics, and antifungal therapy.

OBJECTIVES

To provide an updated, evidence-based Brazilian guideline for the diagnosis and treatment of candidemia and invasive candidiasis in adults and children, incorporating contemporary scientific data and addressing the specific epidemiological, diagnostic, and therapeutic realities of Brazil.

METHODS

This guideline was developed by the SBI Mycology Committee through a structured consensus process. Clinical questions were formulated using the PICO framework, followed by systematic literature searches of PubMed-indexed studies and international guidelines. Recommendations were contextualized according to Brazilian epidemiology, laboratory infrastructure, and access to antifungal therapies.

RESULTS

Key updates include revised epidemiological data from Brazilian cohorts, updated recommendations for blood culture strategies and non-culture-based diagnostics, refined indications for echocardiography and fundoscopy, and updated therapeutic algorithms. Novel antifungal agents, including long acting echinocandins such as rezafungin, are discussed. Emphasis is placed on early echinocandin therapy, timely source control, antifungal stewardship, and infectious diseases consultation.

CONCLUSIONS

This updated Brazilian guideline reflects current scientific evidence while addressing national healthcare realities, aiming to standardize care, improve outcomes, and reduce mortality associated with invasive candidiasis in Brazil.