Therapeutic Approach to Candida Sepsis.

Serious infections due to Candida species are an emerging nosocomial problem. Therapy for culture-proven candidemia in nonneutropenic patients has been studied extensively, and these studies suggest that fluconazole and conventional amphotericin B are equivalent treatments under most circumstances. Empiric antifungal therapy for the seriously ill, febrile, nonneutropenic intensive care unit patient has been less well studied, but an understanding of the important risk factors for invasive candidiasis can help guide rational therapeutic choices. The important role of empiric antifungal therapy in the persistently febrile neutropenic host has been well established. The role of the lipid formulations of amphotericin B in the treatment of candidiasis remains unclear, but these compounds should be considered in any patient requiring amphotericin B with significant renal dysfunction. The trend towards nonalbicans Candida species as a cause of invasive candidiasis, together with an improved understanding of antifungal susceptibility data, should help clinicians and investigators devise new and better approaches to the treatment of this important nosocomial infection.