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
...nagement
...mia in Non-Neutropenic Patie...
...hinocandin (caspofungin, loading dose 70...
...conazole intravenous or oral, 800 m...
...r azole susceptibility is recommended f...
...ition from an echinocandin to flucon...
...infection due to C. glabrata, transition to hig...
...rmulation amphotericin B (AmB) (3-5...
...m AmB to fluconazole is recommended after 5-7...
...mong patients with suspected azole and...
...nazole 400 mg (6 mg/kg) twice daily for 2 do...
...le is recommended as step-down oral therapy for se...
...utropenic patients with candidemia should h...
...cultures should be performed every day or e...
...d duration of therapy for candidemia without ob...
...enous Catheters (CVCs) in Non-Neutropenic Pati...
...VCs should be removed as early as poss...
...emia in Neutropenic Patient...
...ocandin (caspofungin, loading dose 7...
...on AmB, 3-5 mg/kg daily, is an effec...
...conazole, 800 mg (12 mg/kg) loading d...
...ole, 400 mg (6 mg/kg) daily, can be used f...
...conazole, 400 mg (6 mg/kg) twice daily for 2 dose...
...also be used as step-down therapy during neu...
...nfections due to C. krusei, an echinocandin...
...ed minimum duration of therapy for ca...
...l findings of choroidal and vitreal infection are...
...neutropenic patient, sources of candidiasi...
...ized granulocyte transfusions can be co...
...onic Disseminated (Hepatosplenic) Candidi...
Initial therapy with lipid formulation A...
...herapy should continue until lesions resolve o...
...y or hematopoietic cell transplantation is requ...
...ients who have debilitating persistent fevers...
...mpirical Treatment for Suspected Inva...
...al antifungal therapy should be considered in c...
...ical antifungal therapy should be st...
...d empirical therapy for suspected c...
...onazole, 800 mg (12 mg/kg) loading dose,...
...ation AmB, 3-5 mg/kg daily, is an alt...
...nded duration of empirical therapy fo...
...or patients who have no clinical response to...
...Prophylaxis to Prevent Invasive Candidi...
...onazole, 800 mg (12 mg/kg) loading dose, the...
...alternative is to give an echinocandin...
...hing of ICU patients with chlorhexidi...
...onatal Candidiasis, including Central Nervous S...
...ve Candidiasis and Candidemia
...olate, 1 mg/kg daily, is recommend...
...nazole, 12 mg/kg IV or oral daily, is a reason...
...rmulation AmB, 3-5 mg/kg daily, is an altern...
...ocandins should be used with caution and gene...
...ar puncture and a dilated retinal...
...und imaging of the genitourinary tract, liver,...
...venous catheter removal is strongly recommended...
...ommended duration of therapy for candid...
...infections in Neonat...
...tment, AmB deoxycholate, 1 mg/kg IV daily,...
...e regimen is liposomal AmB, 5 mg/kg daily. ( S/...
...ion of flucytosine, 25 mg/kg 4 times daily, may...
...-down treatment after the patient has respo...
...d continue until all signs, symptoms, and CSF...
...devices, including ventriculostomy drains...
...s in the Neonatal ICU Setti...
...series with high rates (>10%) of invasive cand...
...nystatin, 100,000 units 3 times daily for 6...
...lactoferrin (100 mg/day) may be effectiv...
...-Abdominal Candidiasis...
...pirical antifungal therapy should be conside...
...tment of intra-abdominal candidiasis should i...
...antifungal therapy is the same as...
The duration of therapy should be dete...
...dida Species in the Respiratory Tract...
...f Candida from respiratory secretions usually...
...da Intravascular Infections, Including Endocarditi...
...andida Endocar...
...ive valve endocarditis, lipid formulation AmB, 3...
...apy to fluconazole, 400-800 mg (6-12 mg/kg) dai...
...nazole, 200-300 mg (3-4 mg/kg) twice da...
Valve replacement is recommended....
...patients who cannot undergo valve repl...
...c valve endocarditis, the same antifungal regimens...
...suppressive antifungal therapy with fluconaz...
...ida Infection of Implantable Card...
...or pacemaker and implantable cardiac defibrilla...
...therapy is the same as that recommended for nat...
...infections limited to generator pock...
...involving the wires, ≥6 weeks of antifungal the...
...ntricular assist devices that cannot be r...
...c suppressive therapy with fluconazole if the is...
...purative Thrombophlebitis...
...atheter removal and incision and drainage or re...
...ulation AmB, 3-5 mg/kg daily, OR fluconazole, 400...
...wn therapy to fluconazole, 400-800 mg (...
...esolution of the thrombus can be used...
.... Candida Osteoarticular Inf...
...Osteomyelitis...
...azole 400 mg (6 mg/kg) daily, for 6-12 mo...
...d formulation AmB, 3-5 mg/kg daily, for ≥2 week...
...ical debridement is recommended in...
...da Septic Arthritis...
...le, 400 mg (6 mg/kg) daily, for 6 weeks OR...
...formulation AmB, 3-5 mg/kg daily, for...
...ical drainage is indicated in all cases of se...
...arthritis involving a prosthetic dev...
...c device cannot be removed, chronic suppression w...
...ida Endophthalmitis...
General Approach to Candida Endoph...
...th candidemia should have a dilated ret...
...neutropenic patients it is recomme...
...ocular infection (chorioretinitis with o...
...ns regarding antifungal treatment and sur...
...horioretinitis WITHOUT Vitritis...
...fluconazole/voriconazole susceptib...
...nazole/voriconazole resistant isolates, lip...
...ular involvement, antifungal agents as n...
...of treatment should be at least 4-6 weeks, with...
...a Chorioretinitis WITH Vitr...
...tifungal therapy as detailed above for chorioreti...
...hould be considered to decrease the bu...
...tion of treatment should be ≥4-6 w...
XIII. Central Nervous System (CNS) Candi...
...initial treatment, liposomal AmB, 5 mg/kg...
For step-down therapy after the pati...
...continue until all signs and symptoms, cerebrosp...
...CNS devices, including ventriculostomy drains,...
...r patients in whom a ventricular device cannot...
...nary Tract Infections Due to Candida Species...
...tomatic Candiduria...
...of predisposing factors, such as in...
...t with antifungal agents is not re...
...patients and very low birth weight...
...dergoing urologic procedures should be tr...
Symptomatic Candida Cystit...
...e-susceptible organisms, oral fluc...
...fluconazole-resistant C. glabrata, AmB...
...C. krusei, AmB deoxycholate, 0.3-0.6 mg/...
...emoval of an indwelling bladder catheter, if...
...cholate bladder irrigation, 50 mg/L sterile water...
...Ascending Candida Pyelonephritis...
...uconazole-susceptible organisms, oral flucona...
...nazole-resistant C. glabrata, AmB deox...
...onazole-resistant C. glabrata, monothe...
...ei, AmB deoxycholate, 0.3-0.6 mg/kg daily...
...on of urinary tract obstruction is strongl...
...have nephrostomy tubes or stents in...
...iated with Fungus Balls...
Surgical intervention is strongly recommended...
...atment as noted above for cystitis or...
...rough nephrostomy tubes, if present, w...
XV. Vulvovaginal Candidi...
...he treatment of uncomplicated Candida...
...tively, for the treatment of uncomplicated Cand...
...acute Candida vulvovaginitis, fluconazole,...
...abrata vulvovaginitis that is unresponsi...
...r alternative agent for C. glabrata...
A third option for C. glabrata infection i...
...lvovaginal candidiasis, 10-14 days of...
.... Oropharyngeal Candidiasis...
...sease, clotrimazole troches, 10 mg 5 times daily,...
...natives for mild disease include nystatin susp...
...to severe disease, oral fluconazole, 100-200...
...uconazole-refractory disease, itraconazo...
...tives for fluconazole-refractory disease inclu...
Intravenous echinocandin (caspofungin...
...suppressive therapy is usually unnecessary...
...IV-infected patients, antiretroviral therapy is...
...e-related candidiasis, disinfection o...
...sophageal Candidiasis...
...antifungal therapy is always required. A diagnost...
...fluconazole, 200-400 mg (3-6 mg/kg) daily,...
...atients who cannot tolerate oral therapy: Intrave...
...less preferred alternative for those...
...sider de-escalating to oral therap...
...zole-refractory disease, itraconazole solut...
...lternatives for fluconazole-refractory di...
...spension, 400 mg twice daily, or e...
...ts who have recurrent esophagitis, chr...
...or HIV-infected patients, antiretroviral therapy...