Treatment of Blood Culture Positive for Candida glabrata
Initial Management
- The Infectious Diseases Society of America recommends initiating an echinocandin as first-line therapy for bloodstream infections caused by Candida glabrata due to its frequent reduced susceptibility to fluconazole 1
- Obtain follow-up blood cultures every day or every other day to document clearance of the organism, as recommended by the Infectious Diseases Society of America 1
- Perform susceptibility testing on all C. glabrata isolates to guide therapy, as suggested by the Infectious Diseases Society of America 1
- Conduct a dilated ophthalmological examination within the first week after diagnosis to rule out endophthalmitis, as recommended by the Infectious Diseases Society of America 1
Treatment Options
- The Infectious Diseases Society of America recommends echinocandin (strong recommendation; high-quality evidence) as first-line therapy, with options including caspofungin: 70 mg loading dose, then 50 mg daily, micafungin: 100 mg daily, and anidulafungin: 200 mg loading dose, then 100 mg daily 1
- The Infectious Diseases Society of America recommends lipid formulation amphotericin B (3-5 mg/kg daily) as an alternative option (strong recommendation; high-quality evidence) 1
Step-down Therapy Considerations
- The Infectious Diseases Society of America suggests that transition from an echinocandin to fluconazole should only be considered for patients with C. glabrata if the isolate is proven susceptible to fluconazole and the patient is clinically stable, with repeat blood cultures negative 1
- For C. glabrata, the Infectious Diseases Society of America recommends using higher-dose fluconazole (800 mg [12 mg/kg] daily) if step-down therapy is considered 1
Duration of Therapy
- The Infectious Diseases Society of America recommends continuing antifungal therapy for at least 2 weeks after documented clearance of Candida from the bloodstream and resolution of symptoms attributable to candidemia 3