Table 1. Medically significant Candida spp.

While many other species of Candida have been isolated from clinical specimens (307), their significance is unclear. See Eggiman et al. for a discussion of rarer species (146). See Sullivan et al. (560) for a specific discussion of C. dubliniensis.

Table 2. Characteristics of the major Candida spp.

Show are frequency estimates for the species causing invasive disease from (2, 179, 395, 466, 470, 628). Virulence and special clinical associations are discussed and cited in the text.

Table 3. Susceptibility of Candida spp. to antifungal agents

Shown are typical species-specific MIC50s (mg/mL) adapted from reports describing collections of clinical isolates (341, 414, 433, 437, 472, 475). MICs were obtained by the NCCLS M27 methodology (385) for all drugs but amphotericin B. As this method fails to detect amphotericin B-resistant Candida (472), the reported amphotericin B MICs were obtained by a more sensitive method based on use of Antibiotic Medium 3 in a agar-based testing format 614).

Table 4. Interpretive breakpoints for antifungal susceptibility testing [Download PDF]

Shown are the breakpoints in mg/mL for Candida isolates against the indicated antifungal agents (386). A disk diffusion-based testing methodology is also available and provides comparable interpretive categories (388). See text for a discussion of the S-DD and I categories. Below this is shown the most common interpretive categories for isolates of the most common species of Candida. *The voriconazole interpretive breakpoints were approved by the National Committee for Clinical Laboratory Standards in January 2005 and are tentative during a one-year commentary period. Final breakpoints for this compound are expected January 2006.

Table 5. Therapy for Vaginal Candidiasis: Topical Agents  [Download PDF]

• = available in at least one form in the United States without a prescription.

Table 6. Therapies of Choice for Invasive Candidiasis* [Download PDF]

C. albicans: Fluconazole

C. tropicalis: Fluconazole

C. parapsilosis: Fluconazole

C. glabrata: Caspofungin

C. krusei: Caspofungin (IV); voriconazole (PO)

C. lusitaniae: Fluconazole

Species unknown: Caspofungin

Neutropenia: An amphotericin B preparation or caspofungin until neutrophil recovery, then as above.

Febrile neutropenia without proven candidiasis: Caspofungin

Meningitis: Caspofungin should probably be avoided—see text

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*These guidelines apply principally to candidemia but can in general be extrapolated to renal, urinary, ocular, cardiac, pericardial, suppurative vascular (phlebitis), peritoneal, gallbladder, pancreatic, skeletal (osteomyelitis), joint (arthritis), meningeal, and pulmonary candidiasis. Unfortunately, the amount of data in these other settings is limited and there is usually no obvious best choice of therapy. The only other general guidelines are (a) durable cure of infected devices is very difficult to achieve without device removal (although infection can often be suppressed—see for example the section entitled “Candida Endocarditis, Pericarditis, and Suppurative Phlebitis”) and (b) an agent that penetrates well is needed for protected spaces (the eye and brain—see those sections for details). Helpful anecdotes are found in the chapter sections that discuss individual disease forms.

When following these general guidelines, remember also that (a) Candida is not the only yeast to cause invasive fungal infections (be especially alert for cryptococcosis and histoplasmosis), (b) there can be mechanical and pharmacological factors that drive failure or breakthrough (see the section entitled “Persistent and Breakthrough Disease”), and (c) catheters and other potentially infected prosthetic devices usually need to be removed (see sections entitled “Management of Catheters” and “Candida Endocarditis, Pericarditis, and Suppurative Phlebitis”).