invasive%20candidiasis
INVASIVE CANDIDIASIS
Treatment Guideline Chart

Infections caused by Candida sp that is associated w/ candidemia & metastatic organ involvement.

Most common pathogens of invasive candidiasis are Candida albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis, Candida krusei

Early initiation of antifungal therapy w/ adequate source control is essential in the management of invasive candidiasis.

Invasive%20candidiasis Management

Follow Up

Therapy Duration

Candidemia without Neutropenia

  • For clinically stable patients who have isolates susceptible to Fluconazole and have negative repeat BCs on antifungal therapy, it is recommended to transition from an echinocandin to Fluconazole or Amphotericin B to Fluconazole usually within 5-7 days
  • Follow-up BCs should be done every day or every other day
  • In patients without obvious metastatic complication, the duration of therapy is 2 weeks after documented clearance of Candida sp from the bloodstream and resolution of symptoms

Candidemia with Neutropenia

  • In patients without obvious metastatic complication, the duration of therapy is 2 weeks after documented clearance of Candida sp from the bloodstream and resolution of symptoms

Chronic Disseminated (Hepatosplenic)

  • Therapy is usually continued for several months until lesions resolve on repeat imaging
  • Premature discontinuation of antifungal therapy can lead to relapse

Endophthalmitis

  • Duration of therapy should be at least 4-6 weeks depending on the resolution of lesions determined by repeat ophthalmological exam

Monitoring

Monitor Patient’s Clinical and Mycological Response

  • Observe resolution of signs, symptoms, and lesions that are present
  • Repeat fungal cultures as necessary

Candidemia and Acute Hematogenously Disseminated Candidiasis

  • The following should be considered when there is persistent candidemia despite appropriate therapy
    • Possibility of an infected intravascular device
    • Significant immunosuppression
    • Microbiological resistance
  • In this case, the following steps should be taken: 
    • Start therapy with an agent from a different class of antifungals
    • Send isolate for identification to the species level and consider susceptibility testing
    • Remove any infected intravascular device
    • If present, ameliorate immunosuppression

Genitourinary Tract (GUT)

  • In case of persistent candiduria in an immunocompromised patient, do ultrasonography or CT of the kidney
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