Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America

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Abstract

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

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Most cited references 495

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Vulvovaginal candidosis.

Jack D. Sobel (2007)

Despite therapeutic advances, vulvovaginal candidosis remains a common problem worldwide, affecting all strata of society. Understanding of anti-candida host defence mechanisms in the vagina has developed slowly and, despite a growing list of recognised risk factors, a fundamental grasp of pathogenic mechanisms continues to elude us. The absence of rapid, simple, and inexpensive diagnostic tests continues to result in both overdiagnosis and underdiagnosis of vulvovaginal candidosis. I review the epidemiology and pathogenesis of this infection, and also discuss management strategies.

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Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection.

Barbara Stoll, Nellie I Hansen, Ira Adams-Chapman … (2004)

Neonatal infections are frequent complications of extremely low-birth-weight (ELBW) infants receiving intensive care. To determine if neonatal infections in ELBW infants are associated with increased risks of adverse neurodevelopmental and growth sequelae in early childhood. Infants weighing 401 to 1000 g at birth (born in 1993-2001) were enrolled in a prospectively collected very low-birth-weight registry at academic medical centers participating in the National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth outcomes were assessed at a comprehensive follow-up visit at 18 to 22 months of corrected gestational age and compared by infection group. Eighty percent of survivors completed the follow-up visit and 6093 infants were studied. Registry data were used to classify infants by type of infection: uninfected (n = 2161), clinical infection alone (n = 1538), sepsis (n = 1922), sepsis and necrotizing enterocolitis (n = 279), or meningitis with or without sepsis (n = 193). Cognitive and neuromotor development, neurologic status, vision and hearing, and growth (weight, length, and head circumference) were assessed at follow-up. The majority of ELBW survivors (65%) had at least 1 infection during their hospitalization after birth. Compared with uninfected infants, those in each of the 4 infection groups were significantly more likely to have adverse neurodevelopmental outcomes at follow-up, including cerebral palsy (range of significant odds ratios [ORs], 1.4-1.7), low Bayley Scales of Infant Development II scores on the mental development index (ORs, 1.3-1.6) and psychomotor development index (ORs, 1.5-2.4), and vision impairment (ORs, 1.3-2.2). Infection in the neonatal period was also associated with impaired head growth, a known predictor of poor neurodevelopmental outcome. This large cohort study suggests that neonatal infections among ELBW infants are associated with poor neurodevelopmental and growth outcomes in early childhood. Additional studies are needed to elucidate the pathogenesis of brain injury in infants with infection so that novel interventions to improve these outcomes can be explored.

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Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study.

Kevin W. Garey, Milind Rege, Manjunath Pai … (2006)

Inadequate antimicrobial treatment is an independent determinant of hospital mortality, and fungal bloodstream infections are among the types of infection with the highest rates of inappropriate initial treatment. Because of significant potential for reducing high mortality rates, we sought to assess the impact of delayed treatment across multiple study sites. The goals our analyses were to establish the frequency and duration of delayed antifungal treatment and to evaluate the relationship between treatment delay and mortality. We conducted a retrospective cohort study of patients with candidemia from 4 medical centers who were prescribed fluconazole. Time to initiation of fluconazole therapy was calculated by subtracting the date on which fluconazole therapy was initiated from the culture date of the first blood sample positive for yeast. A total of 230 patients (51% male; mean age +/- standard deviation, 56 +/- 17 years) were identified; 192 of these had not been given prior treatment with fluconazole. Patients most commonly had nonsurgical hospital admission (162 patients [70%]) with a central line catheter (193 [84%]), diabetes (68 [30%]), or cancer (54 [24%]). Candida species causing infection included Candida albicans (129 patients [56%]), Candida glabrata (38 [16%]), Candida parapsilosis (25 [11%]), or Candida tropicalis (15 [7%]). The number of days to the initiation of antifungal treatment was 0 (92 patients [40%]), 1 (38 [17%]), 2 (33 [14%]) or > or = 3 (29 [12%]). Mortality rates were lowest for patients who began therapy on day 0 (14 patients [15%]) followed by patients who began on day 1 (9 [24%]), day 2 (12 [37%]), or day > or = 3 (12 [41%]) (P = .0009 for trend). Multivariate logistic regression was used to calculate independent predictors of mortality, which include increased time until fluconazole initiation (odds ratio, 1.42; P < .05) and Acute Physiology and Chronic Health Evaluation II score (1-point increments; odds ratio, 1.13; P < .05). A delay in the initiation of fluconazole therapy in hospitalized patients with candidemia significantly impacted mortality. New methods to avoid delays in appropriate antifungal therapy, such as rapid diagnostic tests or identification of unique risk factors, are needed.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Infect Dis

Journal ID (iso-abbrev): Clin. Infect. Dis

Journal ID (publisher-id): cid

Journal ID (hwp): cid

Title: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America

Publisher: Oxford University Press

ISSN (Print): 1058-4838

ISSN (Electronic): 1537-6591

Publication date (Print): 15 February 2016

Publication date (Electronic): 16 December 2015

Publication date PMC-release: 15 February 2017

Volume: 62

Issue: 4

Pages: e1-e50

Affiliations

[1 ] University of Alabama at Birmingham

[2 ] Veterans Affairs Ann Arbor Healthcare System and University of Michigan Medical School , Ann Arbor

[3 ] University of Wisconsin , Madison

[4 ] University of Pittsburgh , Pennsylvania

[5 ] Johns Hopkins University School of Medicine , Baltimore, Maryland

[6 ] University of Texas Health Science Center , Houston

[7 ] Cooper Medical School of Rowan University , Camden, New Jersey

[8 ] University of Pennsylvania , Philadelphia

[9 ] Georgia Regents University , Augusta

[10 ] Weill Cornell Medical Center and Cornell University , New York, New York

[11 ] Children's Hospital of Pennsylvania , Philadelphia

[12 ] Harper University Hospital and Wayne State University , Detroit, Michigan

Author notes

Correspondence: P. G. Pappas, University of Alabama at Birmingham, Division of Infectious Disease, 229 Tinsley Harrison Tower, 1900 University Blvd, Birmingham, AL 35294-0006 ( pappas@ 123456uab.edu ).

Article

Accession ID: PMC4725385 Pmcid ID: PMC4725385 Pmc-uid ID: 4725385 Publisher ID: civ933

DOI: 10.1093/cid/civ933

PMC ID: 4725385

PubMed ID: 26679628

SO-VID: 5d69e670-9ef1-4bd1-99f9-750f79bc5e52

History

Date received : 28 October 2015

Date accepted : 2 November 2015

Funding

Funded by: the Infectious Diseases Society of America

Funded by: National Institutes of Health http://dx.doi.org/10.13039/100000002

Funded by: NIH

Funded by: National Institute of Dental and Craniofacial Research http://dx.doi.org/10.13039/100000072

Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America

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Abstract

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Point-of-Care Testing for Infectious Diseases Super Collection

Most cited references 495

Vulvovaginal candidosis.

Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection.

Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study.

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