Candida
Key Points
Key Points
There are at least 15 distinct Candida species that cause human disease, but over 90% of invasive disease is caused by the 5 most common pathogens, C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, and C. krusei.
Each of these organisms has unique virulence potential, antifungal susceptibility, and epidemiology.
Taken as a whole, significant infections due to these organisms are generally referred to as “invasive candidiasis,” except for mucosal Candida infections, especially those involving the oropharynx, esophagus and vagina, which are not considered to be classically invasive disease.
Note: All recommended antimicrobial drug doses are for adults. Please consult drug PIs for pediatric doses.
Management
...nagemen...
...ndidemia in Non-Neutropenic Patients...
...ocandin (caspofungin, loading dose 7...
...ole intravenous or oral, 800 mg (12 mg/kg) loading...
...g for azole susceptibility is recommended...
...ion from an echinocandin to fluconazole (usually...
...e to C. glabrata, transition to higher...
...ation amphotericin B (AmB) (3-5 mg/kg dai...
...on from AmB to fluconazole is recommended afte...
...ents with suspected azole and echinocandin-resi...
Voriconazole 400 mg (6 mg/kg) twice daily for...
...zole is recommended as step-down oral thera...
...n-neutropenic patients with candid...
...w-up blood cultures should be performed eve...
...ommended duration of therapy for candidemia witho...
...ral Venous Catheters (CVCs) in Non...
...Cs should be removed as early as possible...
...demia in Neutropenic Patients...
...ocandin (caspofungin, loading dose...
...id formulation AmB, 3-5 mg/kg daily, is an ef...
...conazole, 800 mg (12 mg/kg) loading dose...
...0 mg (6 mg/kg) daily, can be used for...
...onazole, 400 mg (6 mg/kg) twice dai...
...le can also be used as step-down therapy d...
...fections due to C. krusei, an echinocandin, li...
...commended minimum duration of therapy for can...
...almological findings of choroidal and vitr...
...utropenic patient, sources of candid...
...ized granulocyte transfusions can be considered...
...sseminated (Hepatosplenic) Candidiasis...
...therapy with lipid formulation AmB, 3-5 mg...
...herapy should continue until lesions resolve on r...
...or hematopoietic cell transplantation is require...
...ients who have debilitating persistent fevers,...
...mpirical Treatment for Suspected Invasive Candid...
...ntifungal therapy should be considered in critica...
...pirical antifungal therapy should be started as s...
...d empirical therapy for suspected c...
...mg (12 mg/kg) loading dose, then 400 mg (...
...rmulation AmB, 3-5 mg/kg daily, is an alternative...
...ed duration of empirical therapy fo...
...tients who have no clinical response to empiri...
...is to Prevent Invasive Candidiasis in...
...800 mg (12 mg/kg) loading dose, then 400...
...is to give an echinocandin (caspofun...
...hing of ICU patients with chlorhexidine, which...
...natal Candidiasis, including Central Nerv...
Invasive Candidiasis and Can...
...eoxycholate, 1 mg/kg daily, is reco...
...12 mg/kg IV or oral daily, is a reasonable altern...
...lation AmB, 3-5 mg/kg daily, is an altern...
...ns should be used with caution and generally limit...
...ture and a dilated retinal examination are recom...
...T or ultrasound imaging of the genitouri...
...nous catheter removal is strongly r...
...ecommended duration of therapy for candidemia...
...S infections in Neonates
...tment, AmB deoxycholate, 1 mg/kg IV daily, is...
...native regimen is liposomal AmB, 5 m...
...n of flucytosine, 25 mg/kg 4 times daily...
...or step-down treatment after the pa...
...hould continue until all signs, symptoms, a...
...NS devices, including ventriculostomy d...
...rophylaxis in the Neonatal ICU Set...
...eries with high rates (>10%) of invasive candidia...
...ystatin, 100,000 units 3 times daily f...
...ine lactoferrin (100 mg/day) may be...
...-Abdominal Candidiasis...
...ical antifungal therapy should be consider...
...tra-abdominal candidiasis should include...
...he choice of antifungal therapy is the same a...
...uration of therapy should be determined b...
...ndida Species in the Respiratory Tract
...da from respiratory secretions usually indic...
...ida Intravascular Infections, Including Endo...
...a Endocarditis...
...ve valve endocarditis, lipid formul...
...-down therapy to fluconazole, 400-800 mg (6-12...
...ral voriconazole, 200-300 mg (3-4 mg/kg) t...
...lve replacement is recommended. Treatmen...
For patients who cannot undergo valve repla...
For prosthetic valve endocarditis, the same antifu...
...suppressive antifungal therapy with fluconazole,...
Candida Infection of Implantable Cardiac De...
...r pacemaker and implantable cardiac defibrilla...
...apy is the same as that recommended for native v...
...fections limited to generator pockets, 4 wee...
For infections involving the wires, ≥6 wee...
...tricular assist devices that cannot be removed...
...ronic suppressive therapy with flucona...
Candida Suppurative Thrombophlebitis
...and incision and drainage or resectio...
...on AmB, 3-5 mg/kg daily, OR fluconazole...
...n therapy to fluconazole, 400-800...
...of the thrombus can be used as evidence to disc...
...Osteoarticular Infections
...a Osteomyelitis...
...nazole 400 mg (6 mg/kg) daily, for 6-12 month...
...d formulation AmB, 3-5 mg/kg daily, fo...
...ical debridement is recommended in selec...
...ndida Septic Arthritis...
..., 400 mg (6 mg/kg) daily, for 6 weeks OR...
...id formulation AmB, 3-5 mg/kg daily, for 2 weeks,...
...rgical drainage is indicated in all cases...
...ritis involving a prosthetic device...
...the prosthetic device cannot be removed, chr...
...andida Endophthalmitis...
...Approach to Candida Endophthalmiti...
...patients with candidemia should have...
...patients it is recommended to delay the...
...ular infection (chorioretinitis with or without ma...
...rding antifungal treatment and surgical int...
...Chorioretinitis WITHOUT Vit...
...r fluconazole/voriconazole susceptible iso...
For fluconazole/voriconazole resistant isolat...
...lar involvement, antifungal agents as no...
...n of treatment should be at least 4-6 weeks, with...
...da Chorioretinitis WITH V...
...ifungal therapy as detailed above for ch...
...y should be considered to decrease the bu...
...duration of treatment should be ≥4-6 weeks,...
...ntral Nervous System (CNS) Candidiasis
...ial treatment, liposomal AmB, 5 mg/kg...
...-down therapy after the patient has...
...should continue until all signs and sym...
...S devices, including ventriculosto...
...patients in whom a ventricular device cannot b...
...Urinary Tract Infections Due to Candida Spec...
...tomatic Candiduria...
...of predisposing factors, such as indwelling bla...
...h antifungal agents is not recommended un...
...patients and very low birth weight in...
...s undergoing urologic procedures should be...
...atic Candida Cystitis...
...nazole-susceptible organisms, oral fl...
...-resistant C. glabrata, AmB deoxycholate, 0.3-0.6...
...AmB deoxycholate, 0.3-0.6 mg/kg daily, for 1-7 day...
Removal of an indwelling bladder c...
...cholate bladder irrigation, 50 mg/L sterile wa...
...Ascending Candida Pyelonephritis...
...zole-susceptible organisms, oral fluconazole 20...
...fluconazole-resistant C. glabrata, Am...
...r fluconazole-resistant C. glabrata, monot...
For C. krusei, AmB deoxycholate, 0.3-0.6 mg/kg dai...
...limination of urinary tract obstruction...
...nts who have nephrostomy tubes or stents in plac...
...Associated with Fungus Ball...
...rvention is strongly recommended in adults. ( S/L...
...ifungal treatment as noted above for cystit...
Irrigation through nephrostomy tubes...
.... Vulvovaginal Candid...
...treatment of uncomplicated Candida vulvov...
Alternatively, for the treatment of uncompl...
...r severe acute Candida vulvovaginitis,...
...a vulvovaginitis that is unresponsiv...
...tive agent for C. glabrata infection is...
...tion for C. glabrata infection is topical...
...or recurring vulvovaginal candidiasis...
...pharyngeal Candidiasis...
...ld disease, clotrimazole troches, 10 mg 5...
...s for mild disease include nystatin...
...moderate to severe disease, oral fluc...
...azole-refractory disease, itraconazole...
Alternatives for fluconazole-refract...
...echinocandin (caspofungin, 70 mg loading dose, t...
...onic suppressive therapy is usuall...
...patients, antiretroviral therapy is...
...enture-related candidiasis, disinfection...
.... Esophageal Candidias...
...ngal therapy is always required. A diagnos...
...conazole, 200-400 mg (3-6 mg/kg) daily,...
...ents who cannot tolerate oral therapy: In...
...less preferred alternative for those who can...
...onsider de-escalating to oral therap...
...azole-refractory disease, itraconazole...
...tives for fluconazole-refractory di...
...conazole suspension, 400 mg twice daily,...
...who have recurrent esophagitis, chronic sup...
...ed patients, antiretroviral therapy is st...