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Essentials in Candida bloodstream infection

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Abstract

Aims

Due to the increase of severely immunocompromised patients, of invasive procedures including central intravascular catheters, and of the use of broad-spectrum antibiotics, the incidence of Candida bloodstream infections has risen intensely in the last decades. Candida bloodstream infection is a serious disease with high mortality. Optimized diagnostic and therapeutic management can improve outcome. Thus, the aim of our mini-review is to highlight important and often missed opportunities in the management of Candida bloodstream infection.

Methods

We searched the published literature and describe the essentials in the management of Candida bloodstream infection.

Results

Four essentials were identified: (1) isolation of Candida spp. from a blood culture should always be considered relevant and requires treatment. Daily blood cultures should be drawn to determine cessation of candidemia. (2) Central venous catheter (CVC) and/or other indwelling devices should be removed. (3) Echinocandins are the first choice. Antifungal treatment should be continued for at least 14 days after cessation of fungemia. Susceptibility testing should be performed to identify resistance and to facilitate transition to oral treatment. (4) In persistent candidemia, echocardiography is an important investigation; ophthalmoscopy should be considered.

Conclusion

Further efforts should be undertaken to increase the adherence to the essentials in the management of Candia bloodstream infection.

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Authors and Affiliations

  1. Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany

    Sibylle C. Mellinghoff & O. A. Cornely

  2. Department I for Internal Medicine, ECMM Excellence Centre of Medical Mycology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Sibylle C. Mellinghoff, O. A. Cornely & N. Jung

  3. German Centre for Infection Research, Partner-Site Bonn-Cologne (DZIF), Cologne, Germany

    O. A. Cornely

  4. Clinical Trials Centre Cologne (ZKS Köln), University Hospital Cologne, Cologne, Germany

    O. A. Cornely

Authors
  1. Sibylle C. Mellinghoff
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  2. O. A. Cornely
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  3. N. Jung
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Corresponding author

Correspondence to Sibylle C. Mellinghoff.

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Conflict of interest

SCM has nothing to declare. OAC has received research grants from Actelion, Amplyx, Arsanis, Astellas, AstraZeneca, Basilea, Bayer, Cidara, F2G, Gilead, GSK, Leeds University, Matinas, Medicines Company, MedPace, Melinta, Merck/MSD, Miltenyi, Pfizer, Rempex, Roche, Sanofi Pasteur, Scynexis, and Seres is a consultant to Allecra Therapeutics, Amplyx, Actelion, Astellas, Basilea, Cidara, Da Volterra, F2G, Gilead, IQVIA, Janssen, Matinas, Menarini, Merck/MSD, Paratek, PSI, Scynexis, Seres, Summit, Tetraphase, Vical, and received lecture honoraria from Astellas, Basilea, Gilead, Merck/MSD, and Pfizer. NJ has received lecture fees and travel expenses from Novartis and Gilead, as well as lecture fees from Labor Stein GmbH and travel expenses from Basilea. She received fees for carrying out a clinical study commissioned by InfectoPharm Arzneimittel.

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Mellinghoff, S.C., Cornely, O.A. & Jung, N. Essentials in Candida bloodstream infection. Infection 46, 897–899 (2018). https://doi.org/10.1007/s15010-018-1218-1

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  • DOI: https://doi.org/10.1007/s15010-018-1218-1

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