Candida kefyr Infection Management

Treatment Recommendations

The Infectious Diseases Society of America recommends a loading dose of 800 mg (12 mg/kg), then 400 mg (6 mg/kg) daily of fluconazole for candidemia 1
The FDA drug label lists C. kefyr among organisms with ≥90% susceptibility to fluconazole, and clinical case reports document successful treatment with fluconazole, even in cases with high amphotericin B MICs 1
Echinocandins (caspofungin, micafungin, or anidulafungin) demonstrate superior efficacy in experimental models and should be considered for critically ill patients, with dosing as follows: caspofungin (loading dose 70 mg, then 50 mg daily), micafungin (100 mg daily), and anidulafungin (loading dose 200 mg, then 100 mg daily) 1
Liposomal amphotericin B (3-5 mg/kg daily) is an alternative if echinocandins and azoles cannot be used 1

The duration of therapy should be at least 2 weeks after documented clearance from bloodstream and resolution of symptoms 1, 2
Removal of all intravascular catheters is a strong recommendation for candidemia 1, 2
A dilated retinal examination by an ophthalmologist is necessary to exclude endophthalmitis 3
Imaging of kidneys, liver, and spleen is recommended if blood cultures remain persistently positive 2

Asymptomatic candiduria should not be treated, unless the patient is neutropenic or has persistent fever, in which case removal of the urinary catheter alone is often sufficient 5
Source control, including catheter removal and drainage of infected collections, should not be delayed 1, 2