Which biomarkers or diagnostic tools do you prioritize to support the decision to start antifungal treatment in septic patients with no clear source of infection but at high risk for fungal infections?

In general terms we do not use biomarkers to decide to start antifungals in a septic patient. We use them to confirm or rule out the infection once the antifungals were started based on clinical suspicion/presentation. BDG in particular has very good negative predictive value for candidemia, but due...

At our center, we use T2Candida PCR (whole blood) in septic patients suspected of having candidemia specifically. TAT is very good and sens/spec quite reasonable (Clancy et al., PMID 29438475). Cost is a limitation, amongst other issues such as potentially lower sensitivity in intraabdominal abscess...

I do not use. Not actionable.

I use Fungitell if I am suspecting a fungal infection. A negative result doesn’t rule out fungal infection, such as with cryptococcosis. I sometimes start empiric antifungal therapy in high-risk patients.