Delphi consensus guidelines for fungal sepsis in non-neutropenic critically ill patients in resource-limited settings: fungal infection study forum expert recommendations

Fungal sepsis represents a significant cause of morbidity and mortality in non-neutropenic critically ill patients. The epidemiology, diagnostic challenges, and management of fungal sepsis in resource-limited settings differ substantially from those in high-income countries. High-quality evidence specifically addressing the management of fungal sepsis in resource-limited environments remains scarce. The Fungal Infection Study Forum, India, developed this Delphi-based consensus statement to guide the management of fungal sepsis in non-neutropenic, critically ill patients in resource-limited settings. The expert panel comprised specialists in critical care, infectious diseases, clinical mycology, internal medicine, and pulmonary medicine. A structured questionnaire addressing risk factors, diagnostic approaches, and management strategies was developed and distributed. Consensus was defined as ≥ 70% agreement among experts. The expert panel generated 15 consensus recommendations. Key risk factors identified included acute pancreatitis, bowel perforation, gastrointestinal surgeries, prolonged antibiotic therapy, severe liver disease, and poor glycaemic control. ≥10 mL of blood per bottle should be collected from peripheral veins for isolation of the etiological agent. Serum β-D-glucan is a useful adjunctive biomarker, whereas molecular diagnostic tests have limited applicability. Echinocandins are recommended as first-line therapy for proven invasive candidiasis, with step-down to fluconazole after susceptibility confirmation. Managing C. auris candidemia in Indian ICUs was also addressed.