Candidemia/
invasive candidiasis has increased in incidence over the past 15 years. Because of numerous risk factors, intensive care unit patients have a predilection for this type of
infection. Most of these
infections are acquired endogenously, but occasionally may result from an exogenous source. Antifungal prophylaxis and preemptive antifungal
therapy have been developed to prevent
candidemia/
invasive candidiasis. Antifungal prophylaxis with
azoles has been demonstrated to reduce
candidemia, overall mortality, and attributable mortality. This strategy is also effective for the prevention of
invasive fungal infection in
liver transplant recipients. Preemptive treatment appears to be a more focused intervention that uses markers (eg, the presence of colonization) and serologic testing to trigger the initiation of antifungal
therapy. Further developments in serologic testing are necessary to enhance the precision of selecting the patients at risk for
candidemia/
invasive candidiasis. The optimum agent to be used prophylactically and for preemptive
therapy requires further clinical investigation.