{"id":990,"date":"2025-04-27T11:52:38","date_gmt":"2025-04-27T10:52:38","guid":{"rendered":"https:\/\/microregistrar.com\/?p=990"},"modified":"2025-05-15T20:58:53","modified_gmt":"2025-05-15T19:58:53","slug":"summary-global-guideline-for-the-diagnosis-and-management-of-candidiasis-an-initiative-of-the-ecmm-in-cooperation-with-isham-and-asm","status":"publish","type":"post","link":"https:\/\/microregistrar.com\/?p=990","title":{"rendered":"Summary: Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM"},"content":{"rendered":"\n
Introduction<\/h5>\n\n\n\n

Candida species are the predominant cause of fungal infections in patients treated in hospital settings, causing significant morbidity and mortality worldwide. This clinical practice guide summarises evidence-based recommendations from the European Confederation for Medical Mycology (ECMM) global guideline initiative, developed in cooperation with the International Society of Human and Animal Mycology (ISHAM) and the American Society for Microbiology (ASM).<\/p>\n\n\n\n

Audio podcast<\/h2>\n\n\n\n
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Click here<\/a><\/div>\n<\/div>\n\n\n\n
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<\/div>\n\n\n\n
Epidemiology and Risk Factors<\/h5>\n\n\n\n
Type of Candidiasis<\/th>Epidemiology<\/th>Key Risk Factors<\/th><\/tr><\/thead>
Invasive Candidiasis<\/strong><\/td>Estimated 1,565,000+ cases annually
Candidemia is most common presentation
More than 85% of fungemia cases in Europe\/USA<\/td>		Immunosuppression
Critical illness
Indwelling vascular catheters
Abdominal surgery
Prolonged ICU stay
Broad-spectrum antibiotics
Total parenteral nutrition<\/td><\/tr>
Mucocutaneous Candidiasis<\/strong><\/td>Vulvovaginal candidiasis affects 75% of women at least once
Oropharyngeal candidiasis affects up to 20% of advanced HIV patients<\/td>		HIV\/AIDS
Diabetes mellitus
Poor oral hygiene\/dentures
Recent\u00a0antibiotic<\/a>\u00a0therapy
Pregnancy
IL-17 inhibitor therapy<\/td><\/tr>
Emerging Threats<\/strong><\/td>Increasing antifungal resistance
Healthcare-associated transmission<\/td>		C. auris<\/em>\u00a0outbreaks
Fluconazole-resistant\u00a0C. parapsilosis<\/em>
Healthcare environment exposure<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

 <\/h2>\n\n\n\n

Diagnostic Approach<\/h5>\n\n\n\n
Diagnostic Method<\/th>Recommendation Level<\/th>Key Points<\/th><\/tr><\/thead>
Clinical Diagnosis<\/strong><\/td>Strongly recommended<\/td>Detailed patient history and physical examination
Focus on potentially affected organ systems
Imaging for suspected disseminated disease<\/td><\/tr>
Blood Cultures<\/strong><\/td>Strongly recommended<\/td>2-3 blood culture sets (20 mL each)
Daily cultures until clearance documented
Limited sensitivity (\u226450% in deep-seated\u00a0infection<\/a>)<\/td><\/tr>
Direct Microscopy<\/strong><\/td>Strongly recommended<\/td>Apply with optical brighteners
Use with cultures for tissue\/fluid samples<\/td><\/tr>
Species Identification<\/strong><\/td>Strongly recommended<\/td>MALDI-TOF mass spectrometry preferred
Chromogenic media for mixed infections
Sequencing when other methods fail<\/td><\/tr>
Biomarkers<\/strong><\/td>Moderately recommended<\/td>Serum \u03b2-D-glucan (BDG) for presumptive diagnosis
Mannan\/anti-mannan antibody assays
Don’t base treatment solely on biomarkers<\/td><\/tr>
Molecular Tests<\/strong><\/td>Moderately recommended<\/td>Limited range of species detection
Use commercial assays over in-house methods
Helpful when combined with biomarkers<\/td><\/tr>
Susceptibility Testing<\/strong><\/td>Strongly recommended<\/td>EUCAST or CLSI methods
Required for invasive infections
Important for non-responsive mucocutaneous cases<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
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Treatment of Candidemia and Invasive Candidiasis<\/h2>\n\n\n\n
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Candidemia without Organ Involvement<\/h5>\n\n\n\n
Therapy Type<\/th>Agents and Dosing<\/th>Recomm. Level<\/th>Comments<\/th><\/tr><\/thead>
First-line Treatment<\/strong><\/td>Anidulafungin: 200 mg day 1, then 100 mg daily
Caspofungin: 70 mg day 1, then 50 mg daily
Micafungin: 100 mg daily
Rezafungin: 400 mg week 1, then 200 mg weekly<\/td>		Strong<\/td>Broad activity including against\u00a0C. auris<\/em>
Favourable safety profile
Limited drug interactions<\/td><\/tr>
Alternative Options<\/strong><\/td>Liposomal amphotericin B: 3 mg\/kg dailyFluconazole: 400-800 mg dailyVoriconazole: 6 mg\/kg BID day 1, then 4 mg\/kg BID<\/td>Moderate<\/td>For fluconazole: only if the isolate is susceptible
Consider local resistance patterns
Higher toxicity with amphotericin formulations<\/td><\/tr>
Source Control<\/strong><\/td>Central venous catheter removal<\/td>Strong<\/td>Remove as early as possible (<48-72h)
If not feasible, change catheter over guidewire<\/td><\/tr>
Step-down Therapy<\/strong><\/td>Fluconazole 400-800 mg daily<\/td>Moderate<\/td>After 5+ days of echinocandin
Patient stable with negative cultures
Non-neutropenicSource controlledSusceptible isolate<\/td><\/tr>
Duration<\/strong><\/td>14 days after first negative blood culture<\/td>Strong<\/td>Perform daily blood cultures
If positive on day 5, search for persistent source<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

 <\/h3>\n\n\n\n

CNS Candidiasis<\/h5>\n\n\n\n
Therapy Type<\/th>Agents and Dosing<\/th>Recomm. Level<\/th>Comments<\/th><\/tr><\/thead>
First-line Treatment<\/strong><\/td>Liposomal amphotericin B: 3-5 mg\/kg daily \u00b1 flucytosine 150 mg\/kg daily<\/td>Strong<\/td>Good CNS penetration
Synergistic combination<\/td><\/tr>
Alternative<\/strong><\/td>Fluconazole: 800 mg BID \u00b1 flucytosine<\/td>Moderate<\/td>For step-down or consolidation
Only for susceptible isolates<\/td><\/tr>
Surgical Management<\/strong><\/td>Abscess drainage
Device removalVentricular drainage<\/td>		Strong<\/td>Critical for source control
Manage increased intracranial pressure<\/td><\/tr>
Duration<\/strong><\/td>Until clinical and CSF abnormalities resolve<\/td>Strong<\/td>Individualise based on response
Often several months<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

 <\/h3>\n\n\n\n

Candida Endocarditis<\/h5>\n\n\n\n
Therapy Type<\/th>Agents and Dosing<\/th>Recomm. Level<\/th>Comments<\/th><\/tr><\/thead>
Medical Therapy<\/strong><\/td>Liposomal amphotericin B: 3-5 mg\/kg daily \u00b1 flucytosine
OR echinocandin (standard dose)<\/td>		Strong<\/td>Can consider combination therapy<\/td><\/tr>
Surgical Management<\/strong><\/td>Valve replacement\/repair
Device removal<\/td>		Strong<\/td>Within the first week of diagnosis
Essential for the cure<\/td><\/tr>
Duration<\/strong><\/td>Minimum 6 weeks after surgery<\/td>Strong<\/td>Longer if complications present
Lifelong suppression if unable to remove hardware<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

 <\/h3>\n\n\n\n

Ocular Candidiasis<\/h5>\n\n\n\n
Type<\/th>Treatment<\/th>Duration<\/th>Comments<\/th><\/tr><\/thead>
Endophthalmitis<\/strong><\/td>Fluconazole: 400-800 mg dailyVoriconazole: standard doseLiposomal amphotericin B: 3-5 mg\/kg dailyConsider intravitreal amphotericin B<\/td>4-6 weeks<\/td>Consider early vitrectomy
Poor echinocandin penetration<\/td><\/tr>
Chorioretinitis with symptoms<\/strong><\/td>Fluconazole or voriconazole<\/td>4-6 weeks<\/td>For macular involvement
Monitor with serial fundoscopy<\/td><\/tr>
Chorioretinitis without symptoms<\/strong><\/td>Fluconazole or voriconazole<\/td>2 weeks<\/td>If candidemia has resolved
No evidence of other deep sites<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

 <\/h2>\n\n\n\n

Prophylaxis Recommendations<\/h5>\n\n\n\n
Patient Population<\/th>Agent and Dosing<\/th>Recomm.
Level<\/th>		Duration<\/th><\/tr><\/thead>
Abdominal Surgery<\/strong><\/td>Fluconazole: 12 mg\/kg loading, then 6 mg\/kg daily<\/td>Moderate<\/td>For recurrent GI perforations
For anastomotic leakages<\/td><\/tr>
Neutropenia\/ AML<\/strong><\/td>Posaconazole or other mould-active agents<\/td>Strong<\/td>During prolonged neutropenia (\u22657 days)
For induction chemotherapy<\/td><\/tr>
Allogeneic HSCT<\/strong><\/td>Fluconazole: standard dose<\/td>Strong<\/td>From conditioning through engraftment
Extended to day 75 post-HSCT<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

 <\/h2>\n\n\n\n

C. auris Infection<\/a> Prevention and Control<\/h5>\n\n\n\n
Measure<\/th>Recomm<\/th>Implementation<\/th><\/tr><\/thead>
Screening<\/strong><\/td>Strong<\/td>High-risk patients on admission
Close contacts of colonised\/ infected patients
Composite swabs of the axilla and groin<\/td><\/tr>
Isolation<\/strong><\/td>Strong<\/td>Single room when possible
Cohort if necessary<\/td><\/tr>
Environmental Cleaning<\/strong><\/td>Strong<\/td>Sporicidal disinfectants
Hydrogen peroxide, peracetic acid, or chlorine-based
Avoid quaternary ammonium compounds<\/td><\/tr>
Surveillance<\/strong><\/td>Strong<\/td>Monitor for outbreaks
Consider genomic typing<\/td><\/tr>
Deisolation<\/strong><\/td>Moderate<\/td>After 3 negative screens (\u226524h apart)<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

 <\/h2>\n\n\n\n

General Management Principles<\/h5>\n\n\n\n
Principle<\/th>Recomm. Level<\/th>Key Points<\/th><\/tr><\/thead>
Specialist Consultation<\/strong><\/td>Strong<\/td>Infectious diseases or clinical microbiology
Improves guideline adherence and outcomes<\/td><\/tr>
Antifungal Stewardship<\/strong><\/td>Strong<\/td>Essential component of antimicrobial stewardship
Optimise antifungal use
Consider local epidemiology and resistance<\/td><\/tr>
Therapeutic Drug Monitoring<\/strong><\/td>Moderate<\/td>For triazoles and certain populations
Target trough >1 mg\/L for echinocandins
Use in treatment failure cases<\/td><\/tr>
Source Control<\/strong><\/td>Strong<\/td>Catheter removal in candidemia
Drain abscesses
Remove infected prosthetic material when possible<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
\n\n\n\n
Summary of Treatment Approach<\/h5>\n\n\n\n
    \n
  1. Use echinocandins as first-line therapy for candidemia and most invasive candidiasis.<\/li>\n\n\n\n
  2. Remove vascular catheters when possible in candidemia<\/li>\n\n\n\n
  3. Perform daily blood cultures until clearance<\/li>\n\n\n\n
  4. Consider step-down to oral fluconazole when appropriate<\/li>\n\n\n\n
  5. Tailor therapy based on species identification and susceptibility<\/li>\n\n\n\n
  6. Implement rigorous\u00a0infection control<\/a>\u00a0for C. auris<\/li>\n\n\n\n
  7. Consider local epidemiology when selecting empiric therapy<\/li>\n\n\n\n
  8. Consult infectious diseases specialists to optimise management<\/li>\n<\/ol>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    Introduction Candida species are the predominant cause of fungal infections in patients treated in hospital settings, causing significant morbidity and […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"categories":[133,12],"tags":[153,197,198,134],"class_list":["post-990","post","type-post","status-publish","format-standard","hentry","category-guideline","category-mycology","tag-antifungal","tag-candida","tag-candidiasis","tag-guideline"],"_links":{"self":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/990","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=990"}],"version-history":[{"count":1,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/990\/revisions"}],"predecessor-version":[{"id":992,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/990\/revisions\/992"}],"wp:attachment":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=990"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=990"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=990"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}