ORAL candidosis in intensive care unit patients a comprehensive review (2005–2025)

Abstract

Oral candidosis is a common opportunistic mycotic infection in intensive care (ICU) with colonization rates quoted between 27% and 53% depending on when sampling occurs, the method of collection and the critical illness severity. It has been traditionally considered a focal mucosal infection, but increasing epidemiological data indicate oral candidosis represents a clinically relevant source of lower respiratory tract colonization and invasive candidemia, especially in mechanically ventilated adults (Nascimento et al., 2024; Noppè et al., 2024). The profound immune dysregulation of critical illness, broad-spectrum antibiotic exposure, invasive medical devices and impaired oral hygiene provide a conducive environment for such Candida overgrowth. This narrative review of literature accumulated over a period of 2 decades (2005-2025) sought to summarize the evidence on the epidemiology, microbiology, pathogenesis, risk factors for development, methods and tests employed in diagnosis, patterns of antifungal resistance as well as therapy and clinical outcomes related to oral candidosis among critically ill patients. Oral candidosis is considered as a marker for risk to systemic infection and its treatment. There is a clear need for improved epidemiological monitoring, standardized diagnostic pathways, integrated approaches to oral-care informed by specialist assessment and antifungal stewardship that are based on a secure evidence-base in order to reduce morbidity and mortality from this frequently overlooked complication of critical illness.