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
...anageme...
...Candidemia in Non-Neutropeni...
...echinocandin (caspofungin, loading dose 70 m...
...onazole intravenous or oral, 800 mg (12 mg/k...
...le susceptibility is recommended for all blood...
...from an echinocandin to fluconazole (usua...
...or infection due to C. glabrata, tra...
...rmulation amphotericin B (AmB) (3-5 mg/kg daily...
...rom AmB to fluconazole is recommended...
...ients with suspected azole and echinocandin...
...e 400 mg (6 mg/kg) twice daily for 2 dose...
...onazole is recommended as step-down or...
...penic patients with candidemia should have a...
...od cultures should be performed ev...
...mmended duration of therapy for candidemia witho...
...I. Central Venous Catheters (CVCs)...
...Cs should be removed as early as pos...
...didemia in Neutropenic Patients...
...chinocandin (caspofungin, loading dose 70 m...
...lation AmB, 3-5 mg/kg daily, is an effectiv...
..., 800 mg (12 mg/kg) loading dose, then...
...onazole, 400 mg (6 mg/kg) daily, can...
...zole, 400 mg (6 mg/kg) twice daily...
...azole can also be used as step-down t...
...ons due to C. krusei, an echinocandin...
...ecommended minimum duration of therapy for candi...
...thalmological findings of choroidal and...
...ic patient, sources of candidiasis other than a...
...F-mobilized granulocyte transfusions can be...
...isseminated (Hepatosplenic) Candidiasis...
...ial therapy with lipid formulation Am...
...herapy should continue until lesions re...
...erapy or hematopoietic cell transplantation is...
...have debilitating persistent fevers, short term...
...reatment for Suspected Invasive Candidiasis in...
...l antifungal therapy should be considered in cri...
Empirical antifungal therapy should...
...irical therapy for suspected candidiasis in n...
...luconazole, 800 mg (12 mg/kg) loading dose,...
...id formulation AmB, 3-5 mg/kg daily, is an a...
...uration of empirical therapy for suspected...
...ts who have no clinical response to empiri...
...hylaxis to Prevent Invasive Candidia...
...azole, 800 mg (12 mg/kg) loading dose, th...
...is to give an echinocandin (caspofung...
...ily bathing of ICU patients with chlorhexidi...
...Candidiasis, including Central Nervous S...
...ive Candidiasis and Candidem...
...B deoxycholate, 1 mg/kg daily, is reco...
...zole, 12 mg/kg IV or oral daily, is a reasonable...
...n AmB, 3-5 mg/kg daily, is an alternative...
...ns should be used with caution and...
...lumbar puncture and a dilated retina...
...ound imaging of the genitourinary tract, liver, an...
...al venous catheter removal is strongly re...
...mended duration of therapy for candidemia withou...
...infections in Neo...
For initial treatment, AmB deoxycholat...
...ternative regimen is liposomal AmB, 5 mg/kg dai...
...of flucytosine, 25 mg/kg 4 times da...
...n treatment after the patient has respon...
...should continue until all signs, symptoms, and...
...nfected CNS devices, including ventriculostomy d...
...rophylaxis in the Neonatal...
In nurseries with high rates (>10%) of...
...nystatin, 100,000 units 3 times daily for 6 wee...
...ine lactoferrin (100 mg/day) may be effective...
...ra-Abdominal Candidias...
...ungal therapy should be considered for pati...
...reatment of intra-abdominal candid...
...ntifungal therapy is the same as for the tr...
...uration of therapy should be determi...
...Candida Species in the Respiratory Tract...
...wth of Candida from respiratory secretio...
...andida Intravascular Infections, Including Endocar...
...dida Endocarditis...
...ative valve endocarditis, lipid formulatio...
...rapy to fluconazole, 400-800 mg (6-12 mg/kg) daily...
...voriconazole, 200-300 mg (3-4 mg/kg) twice d...
...cement is recommended. Treatment sho...
...r patients who cannot undergo valve replacement, l...
...thetic valve endocarditis, the same a...
...c suppressive antifungal therapy with fluc...
...fection of Implantable Cardiac Devices...
...aker and implantable cardiac defibr...
...ifungal therapy is the same as that recomme...
...fections limited to generator pockets, 4 week...
...ctions involving the wires, ≥6 weeks of ant...
...ventricular assist devices that cannot b...
...suppressive therapy with fluconazole if the...
Candida Suppurative Thrombophleb...
...val and incision and drainage or resec...
...on AmB, 3-5 mg/kg daily, OR fluconazole, 400-80...
...apy to fluconazole, 400-800 mg (6-12 mg/k...
...of the thrombus can be used as evidence...
...Candida Osteoarticular Inf...
...da Osteomyelitis...
...uconazole 400 mg (6 mg/kg) daily, for 6-12 months...
...on AmB, 3-5 mg/kg daily, for ≥2 week...
...l debridement is recommended in selected cases. (...
...andida Septic Arthrit...
...mg (6 mg/kg) daily, for 6 weeks OR...
...ormulation AmB, 3-5 mg/kg daily, for 2 we...
...age is indicated in all cases of s...
...hritis involving a prosthetic device, devi...
...ic device cannot be removed, chronic suppre...
XII. Candida Endophthalmi...
...neral Approach to Candida Endophtha...
...h candidemia should have a dilated retinal examina...
...r neutropenic patients it is recommended t...
The extent of ocular infection (chorioretinitis...
...ions regarding antifungal treatment and sur...
Candida Chorioretinitis WITHOUT Vitri...
...onazole/voriconazole susceptible iso...
...le/voriconazole resistant isolates, liposomal AmB,...
...ith macular involvement, antifungal agents as note...
...of treatment should be at least 4...
...dida Chorioretinitis WITH Vit...
...ifungal therapy as detailed above...
...should be considered to decrease t...
...duration of treatment should be ≥4-6 week...
...Central Nervous System (CNS) C...
...l treatment, liposomal AmB, 5 mg/kg dail...
...herapy after the patient has respo...
...py should continue until all signs...
...NS devices, including ventriculostomy dr...
...ts in whom a ventricular device canno...
...IV. Urinary Tract Infections Due to Candida Speci...
Asymptomatic Can...
...mination of predisposing factors, such as indw...
...h antifungal agents is not recommende...
...ients and very low birth weight infants...
...s undergoing urologic procedures shoul...
...omatic Candida Cystitis...
...susceptible organisms, oral fluconazole, 200...
...le-resistant C. glabrata, AmB deoxycholate,...
...sei, AmB deoxycholate, 0.3-0.6 mg/kg daily, for...
...moval of an indwelling bladder catheter, if...
...deoxycholate bladder irrigation, 50...
...Ascending Candida Pyelonephritis...
...onazole-susceptible organisms, ora...
...resistant C. glabrata, AmB deoxych...
...le-resistant C. glabrata, monotherapy w...
For C. krusei, AmB deoxycholate, 0.3-0...
...nation of urinary tract obstruction is stro...
...who have nephrostomy tubes or stents in...
...Associated with Fungus Ba...
...intervention is strongly recommended in adults. (...
...tifungal treatment as noted above for cystitis...
...through nephrostomy tubes, if present, with...
...Vulvovaginal Candidiasis
...treatment of uncomplicated Candida v...
...tively, for the treatment of uncompl...
...e acute Candida vulvovaginitis, fluconazol...
...vulvovaginitis that is unresponsive...
...lternative agent for C. glabrata infect...
...tion for C. glabrata infection is to...
...recurring vulvovaginal candidiasis,...
...opharyngeal Candidiasis...
...disease, clotrimazole troches, 10 mg 5 times dai...
...or mild disease include nystatin suspension, (10...
...to severe disease, oral fluconazole, 1...
...nazole-refractory disease, itraconazo...
...s for fluconazole-refractory disease include...
...ravenous echinocandin (caspofungin, 70 mg loading...
...sive therapy is usually unnecessary....
...d patients, antiretroviral therapy is str...
...ure-related candidiasis, disinfection of...
...Esophageal Candidiasi...
...ngal therapy is always required. A dia...
Oral fluconazole, 200-400 mg (3-6 mg/kg)...
...ents who cannot tolerate oral therapy: Intraveno...
...ed alternative for those who cannot tolerate oral...
...-escalating to oral therapy with fluconazole 200...
...uconazole-refractory disease, itraconazo...
...atives for fluconazole-refractory diseas...
...ole suspension, 400 mg twice daily, or extended-...
...patients who have recurrent esophagitis, chroni...
...or HIV-infected patients, antiretroviral...