Practical considerations on current guidelines for the management of non-neutropenic adult patients with candidaemia

Authors

  • A. Glöckner,

    1. BDH-Klinik Greifswald, Germany
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  • O. A. Cornely

    1. Department I of Internal Medicine, Clinical Trials Centre Cologne, ZKS Köln, BMBF, Center for Integrated Oncology CIO KölnBonn, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), German Centre for Infection Research, University of Cologne, Cologne, Germany
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A. Glöckner, BDH-Klinik Greifswald, Karl-Liebknecht-Ring 26a, 17491 Greifswald, Germany.
Tel.: +4 938 348 71231. Fax: +4 938 348 71226.
E-mail: a.gloeckner@bdh-klinik-greifswald.de

Summary

Recent guideline recommendations on the management of candidaemia provide valuable treatment guidance for routine clinical practice, but need to be interpreted in the light of the actual situation of the patient and the local epidemiology of fungal infections. Echinocandins emerge as the generally preferred primary treatment. Treatment should be initiated immediately after notification of a Candida-positive blood culture in all patients. Ambiguous issues include the definition of optimum duration of treatment, the indication and time point to step down to oral azoles, catheter management, and the appropriate approach in critically ill patients at high risk for candidaemia in the absence of definitive proof of infection. Patients with clinical suspicion of antifungal treatment failure need prompt workup for adequacy of treatment, focal sources of sustained infection and potential superinfection.

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