From the Guidelines
For treating Candida krusei infections, an echinocandin, lipid formulation AmB, or voriconazole is recommended as initial therapy. This recommendation is based on the strongest and most recent evidence from the Infectious Diseases Society of America's 2016 clinical practice guideline for the management of candidiasis 1. The guideline suggests that echinocandins, such as caspofungin (70mg loading dose, then 50mg daily), micafungin (100mg daily), or anidulafungin (200mg loading dose, then 100mg daily), are effective options for treating C. krusei infections.
Key Considerations
- Echinocandins are recommended as first-line therapy due to their broad spectrum of activity and favorable safety profile 1.
- Lipid formulation AmB is an effective alternative, although it may be less attractive due to the potential for toxicity 1.
- Voriconazole can be used in situations where additional mold coverage is desired or as step-down therapy in clinically stable patients with susceptible isolates 1.
- Fluconazole is not recommended for C. krusei infections due to intrinsic resistance 1.
Treatment Duration and Monitoring
- The recommended minimum duration of therapy for candidemia without metastatic complications is 2 weeks after documented clearance of Candida from the bloodstream, provided neutropenia and symptoms attributable to candidemia have resolved 1.
- Follow-up blood cultures every day or every other day until demonstration of clearance of Candida from the bloodstream are helpful to establish the appropriate duration of antifungal therapy 1.
- A dilated funduscopic examination should be performed within the first week after initiation of specific antifungal therapy to detect potential ocular involvement 1.
From the Research
Characteristics of Candida krusei
- Candida krusei is a diploid, dimorphic ascomycetous yeast that inhabits the mucosal membrane of healthy individuals 2.
- It can cause life-threatening infections in immunocompromised patients, with hematologic malignancy patients and those using prolonged azole prophylaxis being at higher risk 2.
Treatment of Candida krusei Infections
- Candida krusei exhibits intrinsic resistance to fluconazole and decreased susceptibility to amphotericin B and flucytosine 3.
- Treatment options for Candida krusei infections include posaconazole, voriconazole, caspofungin, and micafungin 4, 3, 5.
- Combinations of antifungal agents, such as amphotericin B, posaconazole, caspofungin, and voriconazole, have been shown to be effective against Candida krusei 6.
- Echinocandins, such as micafungin, have been used successfully to treat Candida krusei urinary tract infections, despite their poor urinary concentrations 3.
Antifungal Resistance
- Candida krusei possesses intrinsic resistance to fluconazole and can rapidly develop acquired resistance to other antifungal drugs 2.
- The mechanisms of antifungal resistance in Candida krusei involve the alteration and overexpression of drug targets, reduction in intracellular drug concentration, and development of a bypass pathway 2.
- The antifungal resistance menace, combined with the limited antifungal arsenal and challenges in antifungal drug development, has led researchers to explore alternative therapies 2.