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
Managem...
...in Non-Neutropenic Patients...
...echinocandin (caspofungin, loading...
...avenous or oral, 800 mg (12 mg/kg) loading dose...
...esting for azole susceptibility is recommended fo...
...from an echinocandin to fluconazole...
For infection due to C. glabrata, transition to hi...
...tion amphotericin B (AmB) (3-5 mg/kg...
...ition from AmB to fluconazole is recomme...
...with suspected azole and echinocandi...
...azole 400 mg (6 mg/kg) twice daily for 2 doses, t...
...recommended as step-down oral therapy for select...
...ropenic patients with candidemia sho...
...lood cultures should be performed ev...
...duration of therapy for candidemia without obv...
...ntral Venous Catheters (CVCs) in Non-Neutropen...
...s should be removed as early as possible in the...
...ndidemia in Neutropenic Pat...
...(caspofungin, loading dose 70 mg, then 5...
...tion AmB, 3-5 mg/kg daily, is an effective b...
...e, 800 mg (12 mg/kg) loading dose, then 400 mg (6...
...nazole, 400 mg (6 mg/kg) daily, can be us...
...onazole, 400 mg (6 mg/kg) twice daily...
...ole can also be used as step-down therapy du...
...infections due to C. krusei, an echinocand...
...inimum duration of therapy for candidemia withou...
...halmological findings of choroidal and vitrea...
...ic patient, sources of candidiasis other th...
...CSF-mobilized granulocyte transfusions can be co...
...seminated (Hepatosplenic) Candidiasis...
...therapy with lipid formulation AmB, 3-5 mg/kg d...
...uld continue until lesions resolve on repeat imag...
...therapy or hematopoietic cell transplan...
...patients who have debilitating persis...
...cal Treatment for Suspected Invasive Candidiasis...
...ntifungal therapy should be considered...
Empirical antifungal therapy should...
...ed empirical therapy for suspected candid...
Fluconazole, 800 mg (12 mg/kg) loading dose, then...
...ipid formulation AmB, 3-5 mg/kg daily, is...
...ration of empirical therapy for suspected invasi...
...ts who have no clinical response to empirical anti...
...rophylaxis to Prevent Invasive Candidiasis in the...
...le, 800 mg (12 mg/kg) loading dose, then 400 mg (6...
...ive is to give an echinocandin (ca...
...ly bathing of ICU patients with chlorhexidine, w...
VII. Neonatal Candidiasis, including Central...
...sive Candidiasis and Can...
...e, 1 mg/kg daily, is recommended f...
...conazole, 12 mg/kg IV or oral daily, is a reasonab...
...lation AmB, 3-5 mg/kg daily, is an a...
...ins should be used with caution and gene...
A lumbar puncture and a dilated retinal examinatio...
...d imaging of the genitourinary tract,...
...enous catheter removal is strongly reco...
...ommended duration of therapy for candidemia...
...nfections in Neonates...
...or initial treatment, AmB deoxychola...
...n alternative regimen is liposomal AmB, 5 mg/kg...
...tion of flucytosine, 25 mg/kg 4 times daily, m...
...p-down treatment after the patient...
...ould continue until all signs, symptoms, and CS...
...CNS devices, including ventriculostomy drain...
...laxis in the Neonatal ICU Se...
...s with high rates (>10%) of invasive candidiasis,...
...al nystatin, 100,000 units 3 times dai...
Oral bovine lactoferrin (100 mg/day) may be ef...
...-Abdominal Candidiasis...
...ungal therapy should be considered for pat...
...reatment of intra-abdominal candidiasi...
...hoice of antifungal therapy is the same...
...he duration of therapy should be determ...
...dida Species in the Respiratory Tract...
...dida from respiratory secretions us...
...ravascular Infections, Including Endocarditis...
...a Endocarditis...
For native valve endocarditis, lipid formulati...
...wn therapy to fluconazole, 400-800 mg (6-1...
...onazole, 200-300 mg (3-4 mg/kg) twic...
...ement is recommended. Treatment sh...
...r patients who cannot undergo valve...
...ic valve endocarditis, the same antif...
...essive antifungal therapy with fluconazole, 400-80...
...da Infection of Implantable Cardiac Devices...
...pacemaker and implantable cardiac def...
Antifungal therapy is the same as that recomm...
...imited to generator pockets, 4 weeks o...
...involving the wires, ≥6 weeks of antifungal t...
...ar assist devices that cannot be remov...
...ssive therapy with fluconazole if the isol...
...purative Thrombophlebiti...
...r removal and incision and drainage or...
...id formulation AmB, 3-5 mg/kg daily, OR fluco...
...apy to fluconazole, 400-800 mg (6-12 mg/kg)...
...tion of the thrombus can be used as evidence to...
...da Osteoarticular Infections...
Candida Osteom...
...400 mg (6 mg/kg) daily, for 6-12 mo...
...pid formulation AmB, 3-5 mg/kg daily, for ≥2...
...rgical debridement is recommended i...
...andida Septic Arthriti...
...nazole, 400 mg (6 mg/kg) daily, for 6 weeks O...
...id formulation AmB, 3-5 mg/kg daily, for 2 weeks,...
...nage is indicated in all cases of se...
...thritis involving a prosthetic device,...
...prosthetic device cannot be removed, chron...
.... Candida Endophthalmi...
...proach to Candida Endophthalmitis...
...with candidemia should have a dilated retinal exam...
...c patients it is recommended to delay the examinat...
...he extent of ocular infection (chorioretiniti...
...cisions regarding antifungal treatment and surgica...
...Chorioretinitis WITHOUT Vitrit...
...zole/voriconazole susceptible isolate...
...e/voriconazole resistant isolates, liposoma...
...lar involvement, antifungal agents as noted...
...treatment should be at least 4-6 weeks, wit...
...andida Chorioretinitis WITH Vitr...
...herapy as detailed above for chorioretinit...
Vitrectomy should be considered to decre...
...he duration of treatment should be ≥4...
...al Nervous System (CNS) Candidiasis...
...initial treatment, liposomal AmB, 5 mg/kg dai...
...erapy after the patient has responde...
...should continue until all signs and sympt...
...ed CNS devices, including ventriculostomy drai...
...s in whom a ventricular device cann...
...nary Tract Infections Due to Candida Species...
...symptomatic Candid...
...predisposing factors, such as indwelling bladde...
...ent with antifungal agents is not recommended unl...
...nic patients and very low birth weight infants...
...ergoing urologic procedures should be treated...
...omatic Candida Cystitis...
...onazole-susceptible organisms, oral fluco...
...-resistant C. glabrata, AmB deoxycholate, 0.3-0.6...
...C. krusei, AmB deoxycholate, 0.3-0.6 m...
...indwelling bladder catheter, if feasib...
...B deoxycholate bladder irrigation, 50 mg/L ster...
...Ascending Candida Pyelonephriti...
...fluconazole-susceptible organisms, o...
...fluconazole-resistant C. glabrata, AmB deoxychola...
...r fluconazole-resistant C. glabrata, mon...
.... krusei, AmB deoxycholate, 0.3-0.6 mg/...
...of urinary tract obstruction is strongly...
...have nephrostomy tubes or stents in pla...
...ociated with Fungus Balls...
...l intervention is strongly recommended in...
...treatment as noted above for cystitis or pyelone...
...gation through nephrostomy tubes, if present,...
...ovaginal Candidiasis...
For the treatment of uncomplicated Candida vu...
...vely, for the treatment of uncomplicated Candida...
For severe acute Candida vulvovaginiti...
...rata vulvovaginitis that is unresponsi...
...native agent for C. glabrata infection is nyst...
...ption for C. glabrata infection is to...
...ulvovaginal candidiasis, 10-14 days of indu...
...Oropharyngeal Candidiasis...
...r mild disease, clotrimazole troches, 10 mg 5...
...natives for mild disease include n...
...erate to severe disease, oral fluconaz...
...nazole-refractory disease, itraconazole s...
...s for fluconazole-refractory disease inclu...
...chinocandin (caspofungin, 70 mg loading...
...ppressive therapy is usually unnecess...
...V-infected patients, antiretroviral therapy is s...
...related candidiasis, disinfection of the...
.... Esophageal Candidiasis...
...mic antifungal therapy is always re...
...onazole, 200-400 mg (3-6 mg/kg) daily, for 14...
...o cannot tolerate oral therapy: Int...
...less preferred alternative for those who cannot...
...ider de-escalating to oral therapy wit...
...-refractory disease, itraconazole solution,...
...atives for fluconazole-refractory...
...pension, 400 mg twice daily, or extende...
...who have recurrent esophagitis, chronic sup...
...fected patients, antiretroviral thera...