Source: http://www.asmscience.org/content/book/10.1128/9781555817176.ch27
Timestamp: 2019-04-26 09:56:38+00:00

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This chapter reviews the clinical characteristics and specific treatment recommendations for the various types of invasive candidiasis, beginning with candidemia. Systemic candidiasis refers to end-organ disease stemming from hematogenous seeding, since any blood-borne Candidainfection may infect the organs through which it circulates. The risk factors for candidemia are numerous and well described in the chapter, including neutropenia, receipt of immunosuppressive drugs and other conditions associated with suppressed immune function, receipt of broad-spectrum antibiotics, use of central venous catheters and total parenteral nutrition, gastrointestinal surgery, burn injuries, and hemo-dialysis and other forms of renal replacement therapy. The chapter also reviews empirical therapy and treatment of proven candidemia in both nonneutropenic and neutropenic hosts. Unlike the case with non-neutropenic hosts, the use of empirical antifungal therapy among febrile neutropenic hosts is well established and validated by outcome data in clinical trials. In considering the treatment of proven candidemia it is useful to divide management decisions into those made prior to the identification of Candida species and those made afterwards. Candidemia due to Candida parapsilosis is generally catheter related, favoring routine catheter removal. All patients with candidemia require an ophthalmologic examination to exclude Candida endophthalmitis. This examination is best undertaken after the initiation of therapy and sterilization of the bloodstream, in order to minimize the possibility of subsequently seeding the eye. Similarly, any findings suggestive of an infectious process in other end organs should be investigated to exclude invasive candidiasis.
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