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Towards shorter therapy for candidaemia: defining uncomplicated candidaemia in adults

@ilanareinhold.bsky.social ... @olivercornely.bsky.social

Thoughtful approach to selecting patients for whom shorter candidemia therapy MAY be safe

www.thelancet.com/journals/lan...
Clinical and microbiological criteria evaluated to distinguish uncomplicated from complicated candidaemia Figure 2 Time-dependent criteria proposed to distinguish uncomplicated from complicated candidaemia Timeline depicting the onset of candidaemia (upper blue rectangle), timing of antifungal treatment initiation (upper grey rectangle), and time-dependent criteria. Day 0 refers to initiation of antifungal treatment. Criteria proposed to enter definition of complicated candidaemia are: neutropenia for over 10 days in the past 30 days, ongoing use of glucocorticosteroids for 21 days or more, missing removal of central venous line for over 48 h, missing source control of intra-abdominal candidiasis for over 5 days, and duration of candidaemia for 120 h or more. Panel: Definition criteria for uncomplicated candidaemia after 5 days of treatment Absence of relevant immunosuppression • No neutropenia (<500 cells per μl) for more than 10 days in the last 30 days • No recent or newly initiated ongoing use of glucocorticosteroids (≥0·3 mg/kg per day for ≥3 weeks) • No haematological malignancy without remission • No allogeneic haematopoietic stem-cell transplantation • No acute graft-versus-host disease grade III or IV Absence of active illicit intravenous drug use Controlled source • Central venous line, if any, is removed within 24–48 h after diagnosis of candidaemia • No implantable cardiac electronic device, ventricular assist device, extracorporeal membrane oxygenation, or indwelling intravascular foreign body that cannot be removed present at onset of candidaemia • Intra-abdominal candidiasis (eg, abdominal abscess or peritonitis) is surgically or interventionally controlled Absence of extra-abdominal deep-seated candidiasis • No central nervous system infection, chorioretinitis, endophthalmitis, intravascular infection, endocarditis, renal abscess, osteomyelitis, or joint infection Clinical response • No attributable signs or symptoms for persistent candidaemia 120 h or more after treatment initiation • No signs, symptoms, or indicative imaging for deep- seated candidiasis 120 h or more after treatment initiation Mycological response • Candidaemia less than 120 h between blood draws of the index blood culture and the first negative blood culture Antifungal susceptibility testing available • Absence of echinocandin-resistant Candida species
August 22, 2025 at 2:18 PM