Empirical treatment for invasive Candida infection

Empirical treatment for invasive Candida infection is usually not required. However, patients with sepsis or septic shock who have multiple risk factors for invasive Candida infection are at high risk and empirical therapy should be started. For all other patients, the need for empirical therapy should be considered on a case-by-case basis – see Risk factors for invasive Candida infection.

The proportion of candidaemia caused by organisms other than Candida albicans and those resistant to fluconazole is increasing. Where available, empirical therapy should be guided by local resistance patterns, local epidemiology or antibiograms. In most hospitals, an echinocandin will be the preferred agent.

For patients with sepsis or septic shock at high risk of invasive Candida infection or at intermediate risk but with a high risk of mortality¹, while awaiting the results of culture and susceptibility testing, treat as for Candidaemia (including Candida and related species sepsis).

For patients with recent or extensive prior echinocandin exposure, and in those colonised with echinocandin resistant organisms, seek expert advice.

For advice on managing invasive Candida infection in subpopulations at risk of candidaemia (eg haematology and oncology patients, preterm neonates), follow local or national guidelines.