December 17, 2015
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IDSA updates candidiasis clinical practice guidelines

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The Infectious Diseases Society of America has published revised 2016 guidelines on the treatment and management of invasive Candida infection, including a recommendation that suggests a shift away from fluconazole for initial treatment.

“Invasive infection due to Candida species is largely a condition associated with medical progress, and is widely recognized as a major cause of morbidity and mortality in the health care environment,” Peter G. Pappas, MD, professor of medicine in the division of infectious diseases at the University of Alabama at Birmingham, and colleagues wrote. “Since the last iteration of these guidelines in 2009, there have been new data pertaining to diagnosis, prevention and treatment for proven or suspected invasive candidiasis, leading to significant modifications in our treatment recommendations.”

To update the previous guidelines, a multidisciplinary panel of 12 experts collected and reviewed recent literature focusing on the management of invasive Candida infection. Panel members discussed these data over a 2-year period, and rated the recommendations as “weak” or “strong” using the previously adopted GRADE system of evidence evaluation. Feedback was received from three external peer reviewers, IDSA, the American Academy of Pediatrics and the Pediatric Infectious Diseases Society.

“Virtually anything in the body can be infected with Candida, but infections of the bloodstream, or seeded from the bloodstream — heart, brain, eyes, kidneys, liver — are the ones we worry about the most,” Pappas said in a press release. “These infections are a significant concern among hospitalized patients. In fact, patients who get candidemia are more likely to die than those whose bloodstream infections are caused by bacteria.”

Major updates among the panel’s 140 recommendations include a change from fluconazole to echinocandins for the initial treatment of invasive infections, due to recent evidence of its superior efficacy. The panel also recommended antifungal susceptibility testing to detect resistance, advocated the use of a “step-down” approach from IV to oral treatment delivery, and offered warning signs to ICU physicians unable to diagnose a patient’s deteriorating condition.

Carol A. Kauffman, MD

Carol A. Kauffman

“There is no specific, rapid diagnostic test, and these infections can be difficult to diagnose and treat,” Carol A. Kauffman, MD, chief of the Infectious Diseases Section of the Veterans Affairs Ann Arbor Healthcare System, said in the press release. “Consulting with an ID specialist — who has the expertise to make sense of all the factors involved — is crucial.” – by Dave Muoio

Disclosures: Pappas reports relationships with Astellas, Gilead Sciences, IMMY Diagnostics, Merck, Pfizer, Scynexis, T2 Biosystems and Viamet outside of these guidelines. Kauffman reports relationships with Merck and receives royalties from UpToDate outside of these guidelines. Please see the guidelines for a full list of all other authors’ relevant financial disclosures.