title: Our 2014 approach to candidaemia.
abstract: Candidaemia remains a relevant challenge in everyday patient care on intensive care units and general wards. Delays to adequate treatment increase mortality rates and institutional standard operating procedures facilitate optimal treatment. A positive blood culture requires immediate treatment. Echinocandins are the first-line drugs of choice. Indwelling catheters have to be removed if feasible. Daily blood cultures until persistently negative exclude ongoing fungaemia. In case of Candida parapsilosis antifungal therapy should be switched to intravenous fluconazole. After 10 days of intravenous either echinocandin or fluconazole treatment, step-down to oral application of fluconazole simplifies antifungal therapy. Depending on organ involvement and clinical presentation of the patient antifungal treatment should be continued for at least 14 days after the last positive blood culture. We present our institutional management algorithm for candidaemia which is based on current guidelines and recommendations to improve patient outcome.
authors.affiliation: Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; CECAD - Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Koehler
authors.forename: Daniela
authors.initials: D
authors.lastname: Tacke
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Cornely
mesh_terms: D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D058387:Candidemia / Q000188:drug therapy* / Q000382:microbiology; D054714:Echinocandins / Q000627:therapeutic use*; D006801:Humans
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins
keywords: C. albicans; C. glabrata; C. parapsilosis; echinocandin; fluconazole; liposomal amphotericin B