Academic Journal
Brazilian guidelines for the diagnosis and treatment of candidemia and invasive candidiasis in adults and children.
| Title: | Brazilian guidelines for the diagnosis and treatment of candidemia and invasive candidiasis in adults and children. |
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| Authors: | Colombo AL; Universidade Federal de São Paulo (UNIFESP), Instituto de Resistência Antimicrobiana de São Paulo (ARIES), São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; The Latin American Center for Medical Mycology ‒ CMM LATAM, Brazil. Electronic address: arnaldo.colombo@unifesp.br., Magri MMC; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Clínica de Moléstias Infecciosas e Parasitárias, São Paulo, SP, Brazil; Centro Universitário Faculdade de Medicina do ABC (FMABC), Disciplina de Infectologia, Santo André, SP, Brasil., Carlesse F; Universidade Federal de São Paulo (UNIFESP), Instituto de Resistência Antimicrobiana de São Paulo (ARIES), São Paulo, SP, Brazil; Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC), Instituto de Oncologia Pediátrica, São Paulo, SP, Brazil., Falci DR; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil., Garnica M; Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil., Santos DWCL; IDOR ‒ Instituto D'Or de Pesquisa e Ensino, Rede D'Or, São Luís, MA, Brazil; Hospital Universitário da Universidade Federal do Maranhão, São Luís, MA, Brazil., Queiroz-Telles F; Universidade Federal do Parana, Departamento de Saúde Pública, Curitiba, Brazil., Pasqualotto AC; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil; Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil; University of Minnesota, Minneapolis, MN, USA. Electronic address: pasqualotto@santacasa.org.br. |
| Source: | The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases [Braz J Infect Dis] 2026 Jul-Aug; Vol. 30 (4), pp. 105946. Date of Electronic Publication: 2026 Jul 21. |
| Publication Type: | Journal Article; Practice Guideline; Review |
| Language: | English |
| Journal Info: | Publisher: Elsevier Editora Country of Publication: Brazil NLM ID: 9812937 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1678-4391 (Electronic) Linking ISSN: 14138670 NLM ISO Abbreviation: Braz J Infect Dis Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2010- : Rio de Janeiro : Elsevier Editora Original Publication: Salvador, Bahia, Brazil : Contexto, c1997- |
| MeSH Terms: | Candidemia*/drug therapy , Candidemia*/diagnosis , Antifungal Agents*/therapeutic use , Candidiasis, Invasive*/drug therapy , Candidiasis, Invasive*/diagnosis, Humans ; Brazil ; Adult ; Child |
| Abstract: | 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. (Copyright © 2026 Sociedade Brasileira de Infectologia. Published by Elsevier España, S.L.U. All rights reserved.) |
| Competing Interests: | Conflicts of interest ALC has received support for educational activities from Knight-United Medical, Sandoz, Mundipharma, Accord, Gilead, IMMY, and research grant from Bruker, Knight, Centers for Disease Control-USA (Award Number 1 NU3HCK000010-01-00) and São Paulo Research Foundation ‒ FAPESP (Grants 21/10599-3). MMCM has received support for attending educational meetings from Knight and Mundipharma. FC reports honoraria for lectures from Pfizer, Knight, and Sandoz, and participation in advisory boards for Knight and Pfizer. DRF has received research grants and consulting fees from Pfizer, Merck, and Gilead Sciences; participation on Data Safety Monitoring or Advisory Boards for Gilead Sciences, Merck, and GlaxoSmithKline (GSK); has given paid lectures on behalf of Mundipharma, Sandoz, Pfizer, GSK, Merck, Gilead Sciences, Knight Pharmaceuticals; and received nonfinancial research support from IMMY. ACP has received research grant support from Gilead Sciences, MiraVista Diagnostics, IMMY, the Pan American Health Organization, the Brazilian Innovation Agency – FINEP, and the NIH (Award Number 1R01AI195133-01). He has consulted for Gilead Sciences and Elion Therapeutics, and received support for educational activities from Gilead Sciences, IMMY, Sandoz, Mundipharma, bioMérieux, MSD, Europharma, Pfizer, Takeda, Sanofi, Knight Therapeutics, GSK, and Astellas. Other authors have no conflict of interest to declare. |
| Contributed Indexing: | Keywords: Antifungal therapy; Brazil; Candidemia; Clinical guidelines; Echinocandins; Invasive candidiasis |
| Substance Nomenclature: | 0 (Antifungal Agents) |
| Entry Date(s): | Date Created: 20260721 Date Completed: 20260729 Latest Revision: 20260729 |
| Update Code: | 20260730 |
| PubMed Central ID: | PMC13393635 |
| DOI: | 10.1016/j.bjid.2026.105946 |
| PMID: | 42480284 |
| Database: | MEDLINE |
| ISSN: | 1678-4391 |
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| DOI: | 10.1016/j.bjid.2026.105946 |