Towards shorter therapy for candidaemia: defining uncomplicated candidaemia in adults - 21/08/25

Doi : 10.1016/S1473-3099(25)00409-8

Ilana Reinhold, MD ^a,^b,^c, Susanne Picardi, MD ^f, Blasius Liss, MD ^g,^h, Danila Seidel, PhD ^a,^b,^c, Jannik Stemler, MD ^a,^b,^c,^d, Philipp Koehler, MD ^a,^b,^c,^j, Tamara Ruegamer, MD ⁱ, Rosanne Sprute, MD ^a,^b,^c,^d, Oliver A Cornely, ProfMD ^a,^b,^c,^d,^e,⁎
^a Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
^b Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
^c Department I of Internal Medicine, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
^d German Centre for Infection Research, Cologne, Germany
^e Clinical Trials Centre Cologne, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
^f Department of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany
^g Department Hematology, Oncology, Infectious Disease and Palliative Care, Helios University Hospital Wuppertal, Wuppertal, Germany
^h School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
ⁱ Institute for Medical Microbiology, Immunology, and Hygiene, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
^j Department I of Internal Medicine, Division of Clinical Immunology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany

^*Correspondence to: Prof Oliver A Cornely, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne 50937, GermanyInstitute of Translational ResearchCologne Excellence Cluster on Cellular Stress Responses in Aging-Associated DiseasesFaculty of MedicineUniversity Hospital CologneUniversity of CologneCologne50937Germany

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 21 August 2025

Summary

Although the characteristics of complicated candidaemia are well known, uncomplicated disease remains undefined. Recommended treatment duration for candidaemia is 14 days after bloodstream infection is cleared. Longer treatment duration might be required if candidaemia is complicated by deep organ involvement or by immunocompromising conditions such as neutropenia, uncontrolled haematological malignancy, or in the context of haematopoietic stem-cell transplantation. Complicated candidaemia might further be assumed in prolonged and high-dose glucocorticosteroid exposure, candidaemia recurrence, or with echinocandin-resistant pathogens. In this Review, outcome data were analysed to identify criteria differentiating between complicated and uncomplicated candidaemia in adults. We propose defining uncomplicated candidaemia by controlled source, clinical response, and clearance of the bloodstream within 5 days of appropriate antifungal treatment. Further data are needed to support or challenge our proposed definitions. Shorter treatment courses in this population meeting the definition criteria for uncomplicated candidaemia warrant evaluation in randomised controlled clinical trials.

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