Candidaemia

Notes

Blood stream infections with Candida species are a significant event that is associated with a mortality of up to 47%; if the patient presents with septic shock mortality rates are even higher.

Patients with significant comorbidities and who have received (prolonged) broad spectrum antimicrobials are at particular risk of candidaemia.

Mortality is closely linked to timing of therapy and source control - the earlier appropriate therapy is started and implicated foreign material such as central venous access catheters are removed or infected collections are drained, the better the chances of survival.

If candida is isolated from a blood culture, this should not be regarded as a contaminant.

A consultant microbiologist will follow up all cases of candidaemia and advise on specific antifungal therapy and other aspects of management.

Remove all central venous catheters in non-neutropenic patients.

All patients should be referred to ophthalmology for funduscopic examination - candida endophthalmitis is a sight-threatening complication of candidaemia. 

Patients should be treated for at least 14 days from the next negative blood culture - longer therapy may be required depending on the source and possible complications. 

Patients with persistent candidaemia and those with prosthetic heart valves should have an echocardiogram to rule out infective endocarditis.

For further information, refer to this IDSA guideline.