The presence of Clavispora (most commonly Clavispora lusitaniae, a yeast formerly called Candida lusitaniae) in a respiratory specimen is usually a colonizer rather than a true pathogen. In otherwise healthy patients, or in those without signs of invasive fungal infection (fever, worsening respiratory symptoms, new infiltrates on imaging, or immunosuppression such as neutropenia, recent chemotherapy, solid‑organ transplant, or high‑dose steroids), treatment is not indicated. The appropriate approach is to interpret the culture result in the clinical context, monitor the patient, and treat any underlying bacterial infection as needed.
If the patient is severely immunocompromised, has radiographic evidence of pneumonia that cannot be explained by bacteria, or shows systemic signs suggestive of fungal infection, then antifungal therapy should be considered. First‑line treatment in such cases is usually an echinocandin (e.g., caspofungin 70 mg IV loading dose then 50 mg daily, or micafungin 100 mg IV daily) pending susceptibility results, because some Clavispora isolates can have reduced susceptibility to fluconazole. If susceptibility testing shows fluconazole sensitivity and the patient is stable, fluconazole 400–800 mg IV or PO daily for 2–3 weeks (or longer, depending on clinical response) can be used.
In summary: do not treat an isolated Clavispora from a respiratory culture in a patient without clear evidence of invasive infection; treat only if there are risk factors or clinical signs of fungal pneumonia, using an echinocandin initially and switching to fluconazole if the organism is susceptible.