Treatment of Invasive Candidiasis: A Narrative Review

Abstract

Invasive candidiasis occurs frequently in hospitalized patients, and is associated with high mortality rates due to delays in recognition and initiation of appropriate antifungals. Management of invasive candidiasis must take into account multiple host, pathogen, and drug-related factors, including the site of infection, host immune status, severity of sepsis, resistance and tolerance to antifungal agents, biofilm formation, and pharmacokinetic/pharmacodynamic considerations. Recent treatment directives have been shaped by the widespread introduction of echinocandins, highly potent and safe antifungals, into clinical use, as well as important changes in drug susceptibility patterns and the emergence of known and novel drug-resistant Candida species. Advances in molecular diagnostics have the potential to guide early targeted treatment of high-risk patients.

Keywords: Candida; amphotericin B; candidemia; echinocandin; fluconazole; invasive candidiasis.

Figure 1

Treatment algorithm for patients with suspected or confirmed invasive candidiasis. Scored fill pattern indicates an optional step. For considerations regarding timing of CVC removal, see text. Echinocandin indicates caspofungin, micafungin or anidulafungin. BDG: (1,3)-β-d-glucan; LFAMB: lipid formulation of amphotericin B; CVC: central venous catheter.