From the Guidelines
Nonpharmacologic management of candidemia primarily involves prompt removal or exchange of infected intravascular catheters and devices, ideally within 24-48 hours, as these devices often serve as the source of infection or can develop biofilms that harbor Candida species. Central venous catheters should be removed as soon as possible after candidemia diagnosis, as supported by the Infectious Diseases Society of America guidelines 1. For patients with implanted devices like pacemakers or prosthetic heart valves that cannot be easily removed, careful evaluation for device infection is necessary, potentially requiring surgical intervention if the device is infected.
Some key considerations in nonpharmacologic management include:
- Drainage of any identified abscesses or infected collections is essential.
- Patients should undergo thorough evaluation for metastatic foci of infection, including ophthalmologic examination to rule out endophthalmitis, and echocardiography to assess for endocarditis, particularly with persistent candidemia.
- Strict infection control measures should be implemented to prevent nosocomial spread.
- Nutritional support optimization helps improve immune function, while addressing underlying conditions like uncontrolled diabetes or immunosuppression can help the body fight the infection.
- The decision to remove a catheter should be based on predictors of catheter-related candidemia, such as a >3:1 quantity of Candida growing from the catheter-drawn blood cultures, compared with percutaneous blood cultures, as noted in the guidelines for the diagnosis and management of intravascular catheter-related infection 1.
These nonpharmacologic interventions complement antifungal therapy and are crucial for successful treatment of candidemia, as they target the source of infection and prevent complications that might not be adequately addressed by medications alone, as emphasized in the clinical practice guidelines for the management of candidiasis 1.
From the Research
Non-Pharmacologic Management Strategies for Candidemia
- Removal of central venous catheters (CVC) is a crucial step in managing candidemia, as it can help prevent the persistence of colonization and reduce the risk of antifungal resistance 2, 3
- Lock therapy, which involves filling the catheter lumen with an antifungal or antimicrobial solution, can help prevent biofilm formation and reduce the risk of candidemia 2
- Catheter coating with antifungal or antimicrobial agents can also help prevent biofilm formation and reduce the risk of candidemia 2
- Natural peptide products and photodynamic inactivation are alternative strategies being developed to manage Candida biofilm formation on catheters 2
- Early adequate antifungal therapy is essential in reducing mortality rates in patients with candidemia 4, 3
- Infectious disease consultation can also improve patient outcomes in patients with candidemia 4
- Combined medical and surgical therapy may be necessary in some cases, such as in patients with candidal thrombophlebitis of central veins 5
- Prompt removal of the catheter and administration of adequate antifungal therapy within the first 48 hours can significantly reduce mortality rates in patients with candidemia 3