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:
Candida glabrata (Nakaseomyces glabrata) – some resistance with low dose fluconazole; may be overcome with high dose therapy.
Candida krusei (Pichia kudriavzevii) - resistant to fluconazole
Candida lusitaniae (Clavispora lusitaniae) - usually resistant to amphotericin B.
Candida albicans
Candida tropicalis
Candida parapsilosis
Candida glabrata (Nakaseomyces glabrata)
Candida krusei (Pichia kudriavzevii)
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 |