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.