Candida

Publication Date: December 16, 2015

Key Points

Key Points

Invasive infection due to Candida species is largely a condition associated with medical progress and is widely recognized as a major cause of morbidity and mortality in the healthcare environment.

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

...anageme...

...didemia in Non-Neutropenic Patien...

...ocandin (caspofungin, loading dose 70 m...

Fluconazole intravenous or oral, 800 mg (...

...azole susceptibility is recommended for...

...ition from an echinocandin to fluconazole...

...ction due to C. glabrata, transition to...

Lipid formulation amphotericin B (AmB) (3-5 mg...

...on from AmB to fluconazole is recommended a...

...patients with suspected azole and echinocandin-re...

...00 mg (6 mg/kg) twice daily for 2 doses...

...conazole is recommended as step-down...

...ll non-neutropenic patients with candidemia s...

...w-up blood cultures should be performe...

...ended duration of therapy for candid...


...al Venous Catheters (CVCs) in Non-Ne...

CVCs should be removed as early as possi...


...ia in Neutropenic Patients...

...candin (caspofungin, loading dose 70 mg, then 50 m...

...lation AmB, 3-5 mg/kg daily, is an effective...

...nazole, 800 mg (12 mg/kg) loading d...

Fluconazole, 400 mg (6 mg/kg) daily,...

...zole, 400 mg (6 mg/kg) twice daily for 2 d...

...ole can also be used as step-down therapy durin...

...r infections due to C. krusei, an echinoca...

...mmended minimum duration of therapy for candidemi...

Ophthalmological findings of choroidal...

...ropenic patient, sources of candidias...

...d granulocyte transfusions can be consid...


...Disseminated (Hepatosplenic) Candidiasis...

...ial therapy with lipid formulation AmB, 3...

...d continue until lesions resolve on repeat imag...

...f chemotherapy or hematopoietic cell transplantati...

...patients who have debilitating persi...


...l Treatment for Suspected Invasive Candidiasis in...

...rical antifungal therapy should be con...

...fungal therapy should be started as s...

...empirical therapy for suspected ca...

...nazole, 800 mg (12 mg/kg) loading dose, then 400 m...

...tion AmB, 3-5 mg/kg daily, is an alternative...

...ded duration of empirical therapy for suspec...

...who have no clinical response to empir...


...laxis to Prevent Invasive Candidiasis in the ICU S...

...zole, 800 mg (12 mg/kg) loading dose, then 400 m...

...native is to give an echinocandin (caspofungin,...

...athing of ICU patients with chlorhex...


...II. Neonatal Candidiasis, including Central N...

...sive Candidiasis and Candidemia

AmB deoxycholate, 1 mg/kg daily, is r...

...azole, 12 mg/kg IV or oral daily, is a reasonable...

...on AmB, 3-5 mg/kg daily, is an alternative, but s...

...nocandins should be used with caution and gener...

...lumbar puncture and a dilated retinal examina...

...ultrasound imaging of the genitourina...

...s catheter removal is strongly reco...

...recommended duration of therapy for candide...

...infections in Neon...

...itial treatment, AmB deoxycholate, 1 mg/kg...

...ative regimen is liposomal AmB, 5 mg/kg daily. (...

...he addition of flucytosine, 25 mg/kg 4 times...

...own treatment after the patient has respond...

...ould continue until all signs, symptoms, and CSF...

...ected CNS devices, including ventriculostom...

...in the Neonatal ICU Setting...

...urseries with high rates (>10%) of invasive...

...100,000 units 3 times daily for 6 w...

...al bovine lactoferrin (100 mg/day) may be e...


...Intra-Abdominal Candidiasis...

...antifungal therapy should be consider...

...tra-abdominal candidiasis should include source co...

...ice of antifungal therapy is the same as for the...

...e duration of therapy should be determine...


...Species in the Respiratory Tract...

...Candida from respiratory secretions usually...


...ntravascular Infections, Including Endocardit...

Candida Endocard...

...native valve endocarditis, lipid formulation...

...p-down therapy to fluconazole, 400-800...

...riconazole, 200-300 mg (3-4 mg/kg) twice...

...lve replacement is recommended. Treatment sh...

...tients who cannot undergo valve repla...

...hetic valve endocarditis, the same antif...

...pressive antifungal therapy with fluconazole...

...on of Implantable Cardiac Devices...

...nd implantable cardiac defibrillator inf...

...ngal therapy is the same as that recommended for...

...ions limited to generator pockets, 4 weeks of ant...

...ctions involving the wires, ≥6 weeks of antifung...

...cular assist devices that cannot b...

Chronic suppressive therapy with fluconazole if...

...da Suppurative Thrombophlebi...

Catheter removal and incision and drainage or...

...rmulation AmB, 3-5 mg/kg daily, OR fluco...

...therapy to fluconazole, 400-800 mg (6-12 mg/kg) d...

...the thrombus can be used as evidence t...


...da Osteoarticular Infections...

...andida Osteomye...

...400 mg (6 mg/kg) daily, for 6-12 months OR an ec...

...ulation AmB, 3-5 mg/kg daily, for ≥2 wee...

...debridement is recommended in selected cas...

...Septic Arthritis...

...uconazole, 400 mg (6 mg/kg) daily, for 6 w...

...formulation AmB, 3-5 mg/kg daily, for 2 wee...

...ical drainage is indicated in all cases...

...itis involving a prosthetic device, device removal...

...prosthetic device cannot be removed, chronic...


XII. Candida Endophthalmit...

...roach to Candida Endophthalmitis...

...l patients with candidemia should...

...c patients it is recommended to delay the e...

...e extent of ocular infection (choriore...

...isions regarding antifungal treatment and surgica...

Candida Chorioretinitis WITHOUT Vitr...

For fluconazole/voriconazole susceptible isol...

...onazole/voriconazole resistant isolates, liposoma...

...ith macular involvement, antifunga...

...treatment should be at least 4-6 weeks,...

...ida Chorioretinitis WITH Vitritis...

...tifungal therapy as detailed above for choriore...

...trectomy should be considered to decreas...

...of treatment should be ≥4-6 weeks, wi...


...I. Central Nervous System (CNS) Candidiasis...

...initial treatment, liposomal AmB, 5 mg/kg daily...

...down therapy after the patient has responded to in...

...continue until all signs and sympto...

...d CNS devices, including ventriculostomy drai...

...or patients in whom a ventricular dev...


...act Infections Due to Candida Species...

...matic Candiduria...

...limination of predisposing factors, such as...

...reatment with antifungal agents is not recommend...

Neutropenic patients and very low birth weight i...

...s undergoing urologic procedures should be treate...

...ptomatic Candida Cy...

...onazole-susceptible organisms, oral fluconazole,...

...or fluconazole-resistant C. glabrata, AmB...

...rusei, AmB deoxycholate, 0.3-0.6 mg/kg daily,...

...indwelling bladder catheter, if feasible, is str...

...holate bladder irrigation, 50 mg/L st...

...matic Ascending Candida Pyelonephritis...

...fluconazole-susceptible organisms, oral fluconaz...

...fluconazole-resistant C. glabrata, A...

...luconazole-resistant C. glabrata, monoth...

...rusei, AmB deoxycholate, 0.3-0.6 mg...

...f urinary tract obstruction is stro...

...ho have nephrostomy tubes or stents in pl...

...iated with Fungus Balls...

...tervention is strongly recommended i...

...l treatment as noted above for cystitis or pyelon...

...ugh nephrostomy tubes, if present, with AmB de...


...ulvovaginal Candidiasis...

...atment of uncomplicated Candida vulvo...

...vely, for the treatment of uncomplicated Cand...

...severe acute Candida vulvovaginitis, fl...

...a vulvovaginitis that is unresponsive to oral...

...nother alternative agent for C. glabrata i...

A third option for C. glabrata infection is topi...

...ring vulvovaginal candidiasis, 10-14 d...


...I. Oropharyngeal Candidiasis

...ease, clotrimazole troches, 10 mg 5...

...for mild disease include nystatin suspension...

...e to severe disease, oral fluconazole, 100-200...

...azole-refractory disease, itraconazole s...

...ves for fluconazole-refractory disease include...

...nous echinocandin (caspofungin, 70 mg loading...

...nic suppressive therapy is usually unnecessary. If...

...d patients, antiretroviral therapy is stro...

...denture-related candidiasis, disinfection...


...I. Esophageal Candidiasis...

...ngal therapy is always required. A diagnost...

...azole, 200-400 mg (3-6 mg/kg) daily, for 14-21...

...tients who cannot tolerate oral the...

A less preferred alternative for those who cannot...

...nsider de-escalating to oral therapy with...

...azole-refractory disease, itraconazole solu...

...fluconazole-refractory disease in...

...le suspension, 400 mg twice daily, or extende...

...who have recurrent esophagitis, chronic suppressiv...

...HIV-infected patients, antiretrovi...