Towards shorter therapy for candidaemia: defining uncomplicated candidaemia in adults

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.