, Volume 46, Issue 6, pp 897–899 | Cite as

Essentials in Candida bloodstream infection

  • Sibylle C. MellinghoffEmail author
  • O. A. Cornely
  • N. Jung



Due to the increase of severely immunocompromised patients, of invasive procedures including central intravascular catheters, and of the use of broad-spectrum antibiotics, the incidence of Candida bloodstream infections has risen intensely in the last decades. Candida bloodstream infection is a serious disease with high mortality. Optimized diagnostic and therapeutic management can improve outcome. Thus, the aim of our mini-review is to highlight important and often missed opportunities in the management of Candida bloodstream infection.


We searched the published literature and describe the essentials in the management of Candida bloodstream infection.


Four essentials were identified: (1) isolation of Candida spp. from a blood culture should always be considered relevant and requires treatment. Daily blood cultures should be drawn to determine cessation of candidemia. (2) Central venous catheter (CVC) and/or other indwelling devices should be removed. (3) Echinocandins are the first choice. Antifungal treatment should be continued for at least 14 days after cessation of fungemia. Susceptibility testing should be performed to identify resistance and to facilitate transition to oral treatment. (4) In persistent candidemia, echocardiography is an important investigation; ophthalmoscopy should be considered.


Further efforts should be undertaken to increase the adherence to the essentials in the management of Candia bloodstream infection.


Compliance with ethical standards

Conflict of interest

SCM has nothing to declare. OAC has received research grants from Actelion, Amplyx, Arsanis, Astellas, AstraZeneca, Basilea, Bayer, Cidara, F2G, Gilead, GSK, Leeds University, Matinas, Medicines Company, MedPace, Melinta, Merck/MSD, Miltenyi, Pfizer, Rempex, Roche, Sanofi Pasteur, Scynexis, and Seres is a consultant to Allecra Therapeutics, Amplyx, Actelion, Astellas, Basilea, Cidara, Da Volterra, F2G, Gilead, IQVIA, Janssen, Matinas, Menarini, Merck/MSD, Paratek, PSI, Scynexis, Seres, Summit, Tetraphase, Vical, and received lecture honoraria from Astellas, Basilea, Gilead, Merck/MSD, and Pfizer. NJ has received lecture fees and travel expenses from Novartis and Gilead, as well as lecture fees from Labor Stein GmbH and travel expenses from Basilea. She received fees for carrying out a clinical study commissioned by InfectoPharm Arzneimittel.


  1. 1.
    Murri R, Giovannenze F, Camici M, et al. Systematic clinical management of patients with candidemia improves survival. J Infect. 2018;77:145–50.CrossRefGoogle Scholar
  2. 2.
    Arendrup MC, Sulim S, Holm A, et al. Diagnostic issues, clinical characteristics, and outcomes for patients with fungemia. J Clin Microbiol. 2011;49:3300–8.CrossRefGoogle Scholar
  3. 3.
    Zaoutis TE, Prasad PA, Localio AR, et al. Risk factors and predictors for candidemia in pediatric intensive care unit patients: implications for prevention. Clin Infect Dis Off Publ Infect Dis Soc Am. 2010;51:e38–45.CrossRefGoogle Scholar
  4. 4.
    Barchiesi F, Orsetti E, Osimani P, Catassi C, Santelli F, Manso E. Factors related to outcome of bloodstream infections due to Candida parapsilosis complex. BMC Infect Dis. 2016;16:387.CrossRefGoogle Scholar
  5. 5.
    Mellinghoff SC, Hartmann P, Cornely FB, et al. Analyzing candidemia guideline adherence identifies opportunities for antifungal stewardship. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 2018;37:1563–71.CrossRefGoogle Scholar
  6. 6.
    Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:503–35.CrossRefGoogle Scholar
  7. 7.
    Cornely OA, Bassetti M, Calandra T, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect. 2012;18:19–37.CrossRefGoogle Scholar
  8. 8.
    Andes DR, Safdar N, Baddley JW, et al. Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: a patient-level quantitative review of randomized trials. Clin Infect Dis. 2012;54:1110–22.CrossRefGoogle Scholar
  9. 9.
    Kollef M, Micek S, Hampton N, Doherty JA, Kumar A. Septic shock attributed to Candida infection: importance of empiric therapy and source control. Clin Infect Dis Off Publ Infect Dis Soc Am. 2012;54:1739–46.CrossRefGoogle Scholar
  10. 10.
    Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother. 2005;49:3640–5.CrossRefGoogle Scholar
  11. 11.
    Ostrosky-Zeichner L, Kullberg BJ, Bow EJ, et al. Early treatment of candidemia in adults: a review. Med Mycol. 2011;49:113–20.CrossRefGoogle Scholar
  12. 12.
    Grim SA, Berger K, Teng C, et al. Timing of susceptibility-based antifungal drug administration in patients with Candida bloodstream infection: correlation with outcomes. J Antimicrob Chemother. 2012;67:707–14.CrossRefGoogle Scholar
  13. 13.
    Reboli AC, Rotstein C, Pappas PG, et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med. 2007;356:2472–82.CrossRefGoogle Scholar
  14. 14.
    Cornely OA, Bassetti M, Calandra T, et al. ESCMID guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect. 2012;18:19–37.CrossRefGoogle Scholar
  15. 15.
    Mora-Duarte J, Betts R, Rotstein C, et al. Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med. 2002;347:2020–9.CrossRefGoogle Scholar
  16. 16.
    Kuse ER, Chetchotisakd P, da Cunha CA, et al. Micafungin versus liposomal amphotericin B for candidaemia and invasive candidosis: a phase III randomised double-blind trial. Lancet. 2007;369:1519–27.CrossRefGoogle Scholar
  17. 17.
    Pappas PG, Rotstein CM, Betts RF, et al. Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis. Clin Infect Dis. 2007;45:883–93.CrossRefGoogle Scholar
  18. 18.
    Betts RF, Nucci M, Talwar D, et al. A Multicenter, double-blind trial of a high-dose caspofungin treatment regimen versus a standard caspofungin treatment regimen for adult patients with invasive candidiasis. Clin Infect Dis. 2009;48:1676–84.CrossRefGoogle Scholar
  19. 19.
    Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62:e1–50.CrossRefGoogle Scholar
  20. 20.
    Rex JH, Bennett JE, Sugar AM, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. Candidemia Study Group and the National Institute. N Engl J Med. 1994;331:1325–30.CrossRefGoogle Scholar
  21. 21.
    Clancy CJ, Nguyen MH. Emergence of Candida auris: an international call to arms. Clin Infect Dis. 2017;64:141–3.CrossRefGoogle Scholar
  22. 22.
    Shields RK, Nguyen MH, Press EG, Clancy CJ. Abdominal candidiasis is a hidden reservoir of echinocandin resistance. Antimicrob Agents Chemother. 2014;58:7601–5.CrossRefGoogle Scholar
  23. 23.
    Fernandez-Cruz A, Cruz Menarguez M, Munoz P, et al. The search for endocarditis in patients with candidemia: a systematic recommendation for echocardiography? A prospective cohort. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 2015;34:1543–9.CrossRefGoogle Scholar
  24. 24.
    Card L, Lofland D. Candidal endocarditis presenting with bilateral lower limb ischemia. Clin Lab Sci J Am Soc Med Technol. 2012;25:130–4.Google Scholar
  25. 25.
    Tacke D, Koehler P, Cornely OA. Fungal endocarditis. Curr Opin Infect Dis. 2013;26:501–7.CrossRefGoogle Scholar
  26. 26.
    Kato H, Yoshimura Y, Suido Y, et al. Prevalence of, and risk factors for, hematogenous fungal endophthalmitis in patients with Candida bloodstream infection. Infection. 2018. Scholar
  27. 27.
    Munoz C, Carlet J, Fitting C, Misset B, Bleriot JP, Cavaillon JM. Dysregulation of in vitro cytokine production by monocytes during sepsis. J Clin Invest. 1991;88:141–4.CrossRefGoogle Scholar
  28. 28.
    Munoz P, Vena A, Padilla B, et al. No evidence of increased ocular involvement in candidemic patients initially treated with echinocandins. Diagn Microbiol Infect Dis. 2017;88:141–4.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sibylle C. Mellinghoff
    • 1
    • 2
    Email author
  • O. A. Cornely
    • 1
    • 2
    • 3
    • 4
  • N. Jung
    • 2
  1. 1.Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD)University of CologneCologneGermany
  2. 2.Department I for Internal Medicine, ECMM Excellence Centre of Medical MycologyUniversity Hospital CologneCologneGermany
  3. 3.German Centre for Infection Research, Partner-Site Bonn-Cologne (DZIF)CologneGermany
  4. 4.Clinical Trials Centre Cologne (ZKS Köln)University Hospital CologneCologneGermany

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