Treatment for Candida Infection with Budding Yeast Cells and Pseudo Hyphae

Initial Assessment and Diagnosis

The Infectious Diseases Society of America recommends that blood cultures should be obtained before initiating therapy, though they are often negative in cases of deep-seated candidiasis 1
A laboratory report of yeast obtained from normally sterile sites in patients with clinical evidence of infection should be considered indicative of invasive candidiasis 1
Swabs of superficial wounds and specimens from catheters in place >24 hours do not provide useful diagnostic information and should not be performed 1

The Infectious Diseases Society of America recommends that an echinocandin is the preferred initial therapy for critically ill patients or those with suspected invasive candidiasis due to their broad spectrum activity and favorable safety profile 2, 3
For non-critically ill patients without recent azole exposure, fluconazole is an acceptable alternative: 800 mg loading dose, then 400 mg daily 2

Therapy should continue for at least 14 days after the first negative blood culture and resolution of signs and symptoms associated with infection 5
For deep-seated candidiasis, longer treatment duration of 2-3 weeks is recommended 6
Follow-up blood cultures should be performed daily or every other day until they no longer yield yeast 5
All patients with candidemia should undergo ophthalmological examination to exclude Candida endophthalmitis 5

Source control with adequate drainage and/or debridement is a crucial part of therapy for intra-abdominal candidiasis 1
Empirical antifungal therapy is justified in patients with septic shock in community-acquired infections or post-operative infections where the presence of yeast is associated with poor prognosis 6
In patients with septic shock, absence of source control results in mortality rates above 60% regardless of antifungal therapy 6

De-escalation of antifungal therapy is safe and appropriate once the patient has clinically improved and susceptibility testing results are available 6
Step-down to fluconazole can be considered for susceptible isolates in clinically stable patients 1
De-escalation should be guided by clinical response, microbiology results, and adequacy of source control 1, 2

Delayed initiation of antifungal therapy is associated with increased mortality; treatment should be started within 24 hours of a positive culture 5
Candida glabrata is often resistant to azoles, necessitating echinocandin therapy 6
Antifungal susceptibility testing is recommended for all bloodstream and other clinically relevant Candida isolates to guide optimal therapy 2