Synopsis
Separate colonisation and superficial candidiasis from invasive disease, obtain cultures and source control promptly, deliver species- and susceptibility-directed antifungal therapy, and contain transmissible Candidozyma auris safely.
- Candida commonly colonises the mouth, bowel, genital tract and skin; growth from sputum, a chronic wound or an asymptomatic urinary specimen usually does not prove invasive disease.
- Candidemia is never dismissed as a contaminant. Take blood cultures before antifungal therapy when safe and immediately assess intravascular lines, abdomen, urinary instrumentation, heart, eyes and other metastatic sites.
- First-line treatment for most critically ill adults with candidemia is an intravenous echinocandin, selected from anidulafungin, micafungin or caspofungin according to local formulary.
Key red flags
Shock, rising lactate, acute kidney injury, respiratory failure or altered consciousness with candidemia requires immediate critical-care and infection-specialist involvement.
Persistent fever, rigors or sepsis despite antibacterial therapy may be the only early presentation, particularly with a central line or abdominal source.
Investigation priorities
Recover Candida from blood, establish species and begin the clearance clock for treatment duration.
Management branches
A high-risk patient has unexplained sepsis, persistent fever or yeast signalled in a blood-culture bottle.
- Take peripheral and catheter blood cultures, complete sepsis bloods and sample the most credible source before antifungal treatment if collection will not create harmful delay.
- Start an intravenous echinocandin promptly for unstable or high-risk disease, using an exact local formulary regimen and obtaining microbiology, infection and pharmacy input.
Candidemia or invasive candidiasis is confirmed or strongly suspected in an adult without a site requiring superior CNS, eye or urinary penetration.