New advances in clinical management of candidemia

The overall incidence of candidemia has increased persistently Worldwide during the second half of the 20th century. This increase is the consequence of larger immunocompromised population resulting from their underlying disease, or from their immunosuppressive treatment or intensive care, such as total parenteral nutrition, and central venous catheter placement. The overall mortality of patients with candidemia is high. However, the yield rate of positive blood cultures for candidemia is less than 50%, even in patients with severe neutropenia or immunosuppression, in whom disseminated candidiasis is strongly suspected. Therefore, highly clinical suspicion in identifying patients in high risky groups is needed to guide empirical therapy. All candidemic patients should be treated and the delay in or lack of effective treatment is associated with a grave outcome. In clinical management of patients with candidemia, antifungal agents are used according to the severity of the disease and the causative Candida species. In addition to fluconazole and amphotericin B, the newly developed agents, such as voriconazole and caspofungin, both demonstrate a promising therapeutic efficacy. Whereas, the consensus about the fate of CVC in candidemia patients has not been achieved yet. PCR-based diagnostic strategy, which makes early diagnosis of candidemia possible, may be a new tool for preemptive therapy in febrile neutropenic patients.