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

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; 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

doi:10.1007/s00134-024-07341-7

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

Intensive Care Med. 2024 Apr;50(4):502-515. doi: 10.1007/s00134-024-07341-7. Epub 2024 Mar 21.

Authors

Matteo Bassetti^{1

2}, Daniele R Giacobbe^{3

4}, Christina Agvald-Ohman⁵, Murat Akova⁶, Ana Alastruey-Izquierdo^{7

8}, Sevtap Arikan-Akdagli⁹, Elie Azoulay^{10

11}, Stijn Blot^{12

13}, Oliver A Cornely^{14

15

16

17}, Manuel Cuenca-Estrella⁷, Dylan W de Lange¹⁸, Francesco G De Rosa¹⁹, Jan J De Waele²⁰, George Dimopoulos²¹, Jose Garnacho-Montero²², Martin Hoenigl^{23

24

25}, Souha S Kanj²⁶, Philipp Koehler^{14

27}, Bart J Kullberg²⁸, Frédéric Lamoth^{29

30

31}, Cornelia Lass-Flörl³², Johan Maertens³³, Ignacio Martin-Loeches³⁴, Patricia Muñoz^{35

36

37

38}, Garyphallia Poulakou³⁹, Jordi Rello^{40

41

42

43}, Maurizio Sanguinetti^{44

45}, Fabio S Taccone⁴⁶, Jean-François Timsit^{47

48}, Antoni Torres^{49

50

51

52}, Jose A Vazquez⁵³, Joost Wauters⁵⁴, Erika Asperges⁵⁵, Andrea Cortegiani^{56

57}, Cecilia Grecchi⁵⁸, Ilias Karaiskos⁵⁹, Clément Le Bihan⁶⁰, Toine Mercier^{61

62}, Klaus L Mortensen⁶³, Maddalena Peghin⁶⁴, Chiara Rebuffi⁶⁵, Sofia Tejada^{40

43}, Antonio Vena^{3

4}, Valentina Zuccaro⁵⁵, Luigia Scudeller⁶⁶, Thierry Calandra^{30

31}; 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

Collaborators

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:
Claire Roger, Christian Eckmann, Jean-Pierre Gangneux, Esther Segal, Geoffrey Coombs, Andreas Voss

Affiliations

¹ Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. [email protected].
² Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, L.go R. Benzi 10, 16132, Genoa, Italy. [email protected].
³ Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
⁴ Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, L.go R. Benzi 10, 16132, Genoa, Italy.
⁵ Anaesthesiology and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden.
⁶ Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
⁷ Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
⁸ Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas-CIBERINFEC, Madrid, Spain.
⁹ Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
¹⁰ Université de Paris, Paris, France.
¹¹ Service de Médecine Intensive Et Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France.
¹² Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
¹³ UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
¹⁴ Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
¹⁵ Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
¹⁶ Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.
¹⁷ German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
¹⁸ Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands.
¹⁹ Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy.
²⁰ Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium.
²¹ Department of Critical Care, University Hospital Attikon, Attikon Medical School, National and Kapodistrian University of Athens, Athens, Greece.
²² Intensive Care Unit, Virgen del Rocío University Hospital, Seville, Spain.
²³ Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
²⁴ BioTechMed, Graz, Austria.
²⁵ Translational Mycology Working Group, ECMM Excellence Center for Clinical Mycology, Medical University of Graz, Graz, Austria.
²⁶ Division of Infectious Diseases, and Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon.
²⁷ Medical Faculty and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
²⁸ Department of Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
²⁹ Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
³⁰ Service of Immunology and Allergy and Center of Human Immunology Lausanne, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
³¹ Department of Laboratory Medicine and Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
³² Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria.
³³ Universitair Ziekenhuis Leuven, Louvain, Belgium.
³⁴ Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, Dublin, Ireland.
³⁵ Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
³⁶ Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
³⁷ Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.
³⁸ Medicine Department, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
³⁹ Third Department of Internal Medicine, School of Medicine, Sotiria General Hospital, National and Kapodistrian University, Athens, Greece.
⁴⁰ Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain.
⁴¹ Clinical Research in the ICU, CHU Nimes, Universite de Nimes-Montpellier, Nimes, France.
⁴² Medicine Department, Universitat Internacional de Catalunya (UIC), Sant Cugat, Spain.
⁴³ Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
⁴⁴ Dipartimento di Scienze di Laboratorio E Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁴⁵ Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
⁴⁶ Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium.
⁴⁷ Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Claude Bernard University Hospital, Paris, France.
⁴⁸ IAME UMR 1137, Université Paris-Cité, Paris, France.
⁴⁹ Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.
⁵⁰ August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain.
⁵¹ Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain.
⁵² Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.
⁵³ Department of Medicine/Division of Infectious Disease, Medical College of Georgia/Augusta University, Augusta, GA, USA.
⁵⁴ Medical Intensive Care Unit, University Hospitals Leuven, Louvain, Belgium.
⁵⁵ Infectious Diseases Unit, IRCCS San Matteo, Pavia, Italy.
⁵⁶ Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy.
⁵⁷ Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo, Italy.
⁵⁸ Malattie Infettive, Azienda Socio Sanitaria Territoriale (ASST) di Lodi, Lodi, Italy.
⁵⁹ 1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, Athens, Greece.
⁶⁰ Saint Eloi Department of Anesthesiology and Critical Care Medicine, Montpellier University Health Care Center, Montpellier, France.
⁶¹ Department of Microbiology, Immunology and Transplantation, KU Leuven, Louvain, Belgium.
⁶² Department of Hematology, University Hospitals Leuven, Louvain, Belgium.
⁶³ Department of Medicine, Regional Hospital West Jutland, Herning, Denmark.
⁶⁴ Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy.
⁶⁵ Scientific Direction, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
⁶⁶ Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

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.

Keywords: Aspergillus; Candida; Consensus; Definitions; Diagnosis; Intensive care unit; Invasive fungal diseases; Research.

MeSH terms

Adult
Aspergillosis* / diagnosis
Candidiasis, Invasive* / diagnosis
Consensus
Humans
Intensive Care Units
Invasive Fungal Infections* / diagnosis