Invasive candidiasis / Candidemia

[Clin Infect Dis 2009;48:503-35.]

and

[Can J Infect Dis Med Microbiol 2010;21:e122-50.]

 

General Management

- Removal of central venous and/or peritoneal dialysis catheters generally recommended in non-neutropenic patients but controversial for neutropenic patients as source often from GI tract.

- Discontinue broad spectrum antibiotics if possible.

- Serial blood cultures (minimum daily x 3) to ensure sterilization.

- Fundoscopic examination should be considered.

- For positive Candida spp cultures:

  • C. glabrata – some resistance with low dose fluconazole; may be overcome with high dose therapy.

  • C. krusei - resistant to fluconazole

  • C. lusitaniae - usually resistant to amphotericin B.

Usual Pathogens

Candida albicans
Candida tropicalis
Candida parapsilosis
Candida glabrata
Candida krusei

Hemodynamically stable, no azole exposure in past 3 months

Empiric Therapy Dose Duration
Fluconazole 800mg (12mg/kg) IV loading dose then 400mg (6mg/kg) IV/PO daily minimum 14 days after first negative blood culture and resolution of signs & symptoms

Hemodynamically unstable or azole exposure in past 3 months

Empiric Therapy Dose Duration
Anidulafungin 200mg IV once then 100mg IV daily minimum 14 days after first negative blood culture and resolution of signs & symptoms
or    
Caspofungin 70mg IV once then 50mg IV daily minimum 14 days after first negative blood culture and resolution of signs & symptoms
or    
Micafungin 100mg IV daily minimum 14 days after first negative blood culture and resolution of signs & symptoms
or    
Amphotericin B 0.5-1mg/kg IV daily minimum 14 days after first negative blood culture and resolution of signs & symptoms