candidemia

Candidemia is the presence of Candida species in the bloodstream, representing a form of invasive candidiasis and a common cause of nosocomial bloodstream infection. It most often occurs in hospitalized or immunocompromised patients, particularly those in intensive care units. The species most frequently implicated are Candida albicans and non-albicans species such as C. glabrata, C. tropicalis, C. parapsilosis, and C. krusei, with regional differences in prevalence and antifungal susceptibility.

Risk factors include central venous catheters, prolonged broad-spectrum antibiotic use, parenteral nutrition, abdominal surgery, hematologic malignancies, neutropenia, immunosuppressive therapy, advanced age, and prior antifungal exposure. Clinical presentation is variable and often nonspecific; fever or persistent sepsis despite antibacterial therapy is common, and hypotension or organ dysfunction may occur in severe cases. Definitive diagnosis relies on isolation of Candida from blood cultures, though cultures may be slow or initially negative. Supplemental diagnostic tools include biomarkers such as beta-D-glucan and molecular or MALDI-TOF methods to aid rapid identification and susceptibility interpretation.

Management requires prompt antifungal therapy and source control. First-line treatment in most adults is an echinocandin (eg, caspofungin, micafungin, anidulafungin), with a switch to fluconazole guided by species susceptibility and prior azole exposure. In hemodynamically stable patients with susceptible strains and no prior azole use, fluconazole may be considered. Duration typically ranges from at least 14 days after the last positive culture and resolution of symptoms. Removal of intravascular catheters should be pursued when feasible.

Prognosis is variable but remains associated with high mortality, influenced by illness severity and promptness of treatment. Prevention focuses on infection control, minimizing unnecessary catheter use, and antifungal stewardship to reduce resistance.