ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients
Open accessAbstract
This part of the EFISG guidelines focuses on non-neutropenic adult patients. Only a few of the numerous recommendations can be summarized in the abstract. Prophylactic usage of fluconazole is supported in patients with recent abdominal surgery and recurrent gastrointestinal perforations or anastomotic leakages. Candida isolation from respiratory secretions alone should never prompt treatment. For the targeted initial treatment of candidaemia, echinocandins are strongly recommended while liposomal amphotericin B and voriconazole are supported with moderate, and fluconazole with marginal strength. Treatment duration for candidaemia should be a minimum of 14 days after the end of candidaemia, which can be determined by one blood culture per day until negativity. Switching to oral treatment after 10 days of intravenous therapy has been safe in stable patients with susceptible Candida species. In candidaemia, removal of indwelling catheters is strongly recommended. If catheters cannot be removed, lipid-based amphotericin B or echinocandins should be preferred over azoles. Transoesophageal echocardiography and fundoscopy should be performed to detect organ involvement. Native valve endocarditis requires surgery within a week, while in prosthetic valve endocarditis, earlier surgery may be beneficial. The antifungal regimen of choice is liposomal amphotericin B +/- flucytosine. In ocular candidiasis, liposomal amphotericin B +/- flucytosine is recommended when the susceptibility of the isolate is unknown, and in susceptible isolates, fluconazole and voriconazole are alternatives. Amphotericin B deoxycholate is not recommended for any indication due to severe side effects.
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There is an increasing incidence of azole resistance particularly among non-albicans Candida species.
“The most recent Infectious Disease Society of America (IDSA)125 and European guidelines126,127 recommend echinocandins as first-line initial treatment for most invasive candidiasis in both neutropenic and non-neutropenic patients prior to identification to the species level due to their broad spectrum of activity, favorable side effect profile, mortality benefit, and the increasing incidence of az”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [132]
Echinocandins have a broad spectrum of activity, favorable side effect profile, and mortality benefit in invasive candidiasis.
“The most recent Infectious Disease Society of America (IDSA)125 and European guidelines126,127 recommend echinocandins as first-line initial treatment for most invasive candidiasis in both neutropenic and non-neutropenic patients prior to identification to the species level due to their broad spectrum of activity, favorable side effect profile, mortality benefit, and the increasing incidence of az”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [132]
Echinocandins are recommended as first-line drugs in the treatment of most types of invasive candidiasis on the basis of studies that have shown improved survival or reduced toxicity in comparison with other antifungal classes.
“Echinocandins are recommended as first-line drugs in the treatment of most types of invasive candidiasis on the basis of studies that have shown improved survival or reduced toxicity in comparison with other antifungal classes.”
The shift from C. albicans to species that are more frequently resistant or tolerant to fluconazole, such as C. glabrata and C. krusei, has impacted treatment recommendations.
“The shift from C. albicans, which is overwhelmingly susceptible to all systemic antifungals, to species that are more frequently resistant or tolerant to fluconazole, such as C. glabrata and C. krusei, has impacted treatment recommendations [11,12,13].”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [11]
Endocarditis was clinically unsuspected in a third of the cases, prompting a recommendation for TEE in all patients with candidemia.
“Importantly, endocarditis was clinically unsuspected in a third of the cases, prompting a recommendation for TEE in all patients with candidemia [11].”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [11]
Despite contradictory data from a post-hoc analysis of 2 clinical trials, it is generally accepted that indwelling CVCs should be removed as early as possible in all patients with candidemia.
“Despite contradictory data from a post-hoc analysis of 2 clinical trials [98], it is generally accepted that indwelling CVCs should be removed as early as possible in all patients with candidemia [11,12,84,96].”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [11]
The echinocandins have been recommended as first-line agents for invasive candidiasis.
“They display in vitro fungicidal activity against most Candida species, attractive tolerability and pharmacokinetic profiles, and have been recommended as first line agents for invasive candidiasis (1–6).”
From Echinocandin resistance: an emerging clinical problem? (2014) · cites this paper as [3]
Because fungal biofilms are largely resistant to current antifungal drugs, high antifungal doses together with removal of the colonized medical device are generally required to treat infections.
“Because fungal biofilms are largely resistant to current antifungal drugs, high antifungal doses together with removal of the colonized medical device are generally required to treat infections (6, 29, 104, 112, 121).”
From <i>Candida albicans</i> Biofilms and Human Disease (2015) · cites this paper as [29]
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- Authors
- Cornely, O. A., Bassetti, M., Calandra, T., Garbino, J., Kullberg, B. J., Lortholary, O., Meersseman, W., Akova, M., Arendrup, M. C., Arikan-Akdagli, S., Bille, J., Castagnola, E., Cuenca-Estrella, M., Donnelly, J. P., Groll, A. H., Herbrecht, R., Hope, W. W., Jensen, H. E., Lass-Florl, C., Petrikkos, G., Richardson, M. D., Roilides, E., Verweij, P. E., Viscoli, C., & Ullmann, A. J.
- Affiliations
- University of Cologne (DE)
- Ospedale Santa Maria della Misericordia di Udine (IT)
- Centre Hospitalier Universitaire Vaudois (CH)
- University Hospital of Geneva (CH)
- Radboud University Medical Center (NL)
- Hôpital Necker-Enfants Malades (FR)
- Universitair Ziekenhuis Leuven (BE)
- Hacettepe University (TR)
- Statens Serum Institut (DK)
- Istituto Giannina Gaslini (IT)
- University Hospital Münster (DE)
- Hôpital d'Hautepierre (FR)
- University of Liverpool (GB)
- University of Copenhagen (DK)
- Manchester Academic Health Science Centre (GB)
- Aristotle University of Thessaloniki (GR)
- University of Genoa (IT)
- University of Würzburg (DE)
- Corresponding author
- Cornely, O.A.
- Ullmann, A.J.
- ORCID
- Venue
- Clinical Microbiology and Infection
- Publisher
- Elsevier BV
- Published
- 2012-12
- Volume
- 18
- Pages
- 19-37
- ISSN
- 1198-743X (ISSN-L)
- OpenAlex
- W2163845781
- Cited by
- 1,217
- References
- 170
- Citations by year
- 2026: 35 · 2025: 63 · 2024: 66 · 2023: 73 · 2022: 85 · 2021: 82 · 2020: 92 · 2019: 103 · 2018: 94 · 2017: 123 · 2016: 107 · 2015: 107 · 2014: 112 · 2013: 68 · 2012: 3
- FWCI
- 64.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Clinical Microbiology and Infection (publishedVersion)
- PubMed (publishedVersion)
- Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Institutional Research Information System (University of Udine) (submittedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- IRIS (submittedVersion)
- Hacettepe University Institutional Repository (hacettepe.edu.tr) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- National Institute for Health and Care Research (CS/08/08/10)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Keywords
- candidiasis, candidemia, echinocandins, liposomal amphotericin B, voriconazole, fluconazole, antifungal prophylaxis, abdominal surgery, ocular candidiasis, transesophageal echocardiography, fundus examination, 5-fluorocytosine, amphotericin B deoxycholate, treatment duration
- MeSH terms
- Adult, Antifungal Agents, Candida, Candidiasis, Humans, Evidence-Based Medicine
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