title: Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy.
abstract: Invasive Candida infections are important causes of morbidity and mortality in immunocompromised and hospitalised patients. This article provides the joint recommendations of the German-speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMyKG) and the Paul-Ehrlich-Society for Chemotherapy (PEG) for diagnosis and treatment of invasive and superficial Candida infections. The recommendations are based on published results of clinical trials, case-series and expert opinion using the evidence criteria set forth by the Infectious Diseases Society of America (IDSA). Key recommendations are summarised here: The cornerstone of diagnosis remains the detection of the organism by culture with identification of the isolate at the species level; in vitro susceptibility testing is mandatory for invasive isolates. Options for initial therapy of candidaemia and other invasive Candida infections in non-granulocytopenic patients include fluconazole or one of the three approved echinocandin compounds; liposomal amphotericin B and voriconazole are secondary alternatives because of their less favourable pharmacological properties. In granulocytopenic patients, an echinocandin or liposomal amphotericin B is recommended as initial therapy based on the fungicidal mode of action. Indwelling central venous catheters serve as a main source of infection independent of the pathogenesis of candidaemia in the individual patients and should be removed whenever feasible. Pre-existing immunosuppressive treatment, particularly by glucocorticosteroids, ought to be discontinued, if feasible, or reduced. The duration of treatment for uncomplicated candidaemia is 14 days following the first negative blood culture and resolution of all associated symptoms and findings. Ophthalmoscopy is recommended prior to the discontinuation of antifungal chemotherapy to rule out endophthalmitis or chorioretinitis. Beyond these key recommendations, this article provides detailed recommendations for specific disease entities, for antifungal treatment in paediatric patients as well as a comprehensive discussion of epidemiology, clinical presentation and emerging diagnostic options of invasive and superficial Candida infections.
authors.affiliation: Medizinische Klinik m S Onkologie u Hämatologie, Charité Universitätsmedizin, Charité, Campus Mitte, Berlin, Germany. markus.ruhnke@charite.de
authors.forename: Markus
authors.initials: M
authors.lastname: Ruhnke
authors.forename: Volker
authors.initials: V
authors.lastname: Rickerts
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Cornely
authors.forename: Dieter
authors.initials: D
authors.lastname: Buchheidt
authors.forename: Andreas
authors.initials: A
authors.lastname: Glöckner
authors.forename: Werner
authors.initials: W
authors.lastname: Heinz
authors.forename: Rainer
authors.initials: R
authors.lastname: Höhl
authors.forename: Regine
authors.initials: R
authors.lastname: Horré
authors.forename: Meinolf
authors.initials: M
authors.lastname: Karthaus
authors.forename: Peter
authors.initials: P
authors.lastname: Kujath
authors.forename: Birgit
authors.initials: B
authors.lastname: Willinger
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Presterl
authors.forename: Peter
authors.initials: P
authors.lastname: Rath
authors.forename: Jörg
authors.initials: J
authors.lastname: Ritter
authors.forename: Axel
authors.initials: A
authors.lastname: Glasmacher
authors.forename: Cornelia
authors.initials: C
authors.lastname: Lass-Flörl
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Groll
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D002177:Candidiasis / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008828:Microbiological Techniques / Q000379:methods
chemical_list: D000935:Antifungal Agents