Consensus guidelines for the treatment of yeast infections in the haematology, oncology and intensive care setting, 2014

Abstract

Pathogenic yeast forms are commonly associated with invasive fungal disease in the immunocompromised host, including patients with haematological malignancies and patients of haemopoietic stem cell transplants. Yeasts include the Candida spp., Cryptococcus spp., Pneumocystis jirovecii and some lesser-known pathogens. Candida species remain the most common cause of invasive yeast infections (and the most common human pathogenic fungi). These guidelines present evidence-based recommendations for the antifungal management of established, invasive yeast infections in adult and paediatric patients in the haematology/oncology setting. Consideration is also given to the critically ill patient in intensive care units, including the neonatal intensive care unit. Evidence for 'preemptive' or 'diagnostic-driven antifungal therapy' is also discussed. For the purposes of this paper, invasive yeast diseases are categorised under the headings of invasive candidiasis, cryptococcosis and uncommon yeast infections. Specific recommendations for the management of Pneumocystis jirovecii are presented in an accompanying article (see consensus guidelines by Cooley et al. appearing elsewhere in this supplement).

Online Databases for Taxonomy and Identification of Pathogenic Fungi and Proposal for a Cloud-Based Dynamic Data Network Platform

“…Undeniably delayed treatment of fungal infections leads to adverse outcomes. However, the prerequisite for early targeted therapy is accurate and timely fungal species identification (ID) (8), which currently is only partially been realized by robust accessible diagnostic platforms (9). Molecular biology now allows for a more objective approach to fungal phylogeny and subsequent correct identification, but at the same time, it produces ever-increasing amounts of sequence data.…”

Diagnosis, management and prevention of Candida auris in hospitals: position statement of the Australasian Society for Infectious Diseases

“…In neonates and children there are limited data regarding the PK/PD, safety and efficacy of anidulafungin. Therefore, if echinocandins are prescribed, micafungin or caspofungin is favoured …”

“…The efficacy of combination antifungals in treatment of C . auris infection has not been established, hence, there is no recommendation for combination therapy . Combination therapy may be necessary for urinary tract or CNS infections .…”

“…Therefore, if echinocandins are prescribed, micafungin or caspofungin is favoured. 29,68 Choice of directed antifungal therapy should be individualised based on susceptibility results and clinical site(s) of disease. C. auris can develop resistance rapidly, hence, follow-up cultures should be performed and any subsequent isolates should undergo repeat susceptibility testing.…”

Critical review of current clinical practice guidelines for antifungal therapy in paediatric haematology and oncology

“…We were pleased that a previous version of the Australasian paediatric antifungal guidelines (2007) was included [3], yet note that the comprehensive update of paediatric and adult Australian and New Zealand antifungal guidelines were omitted [4][5][6][7][8][9][10][11][12]. Published in December 2014, these expanded guidelines included manuscripts on prophylaxis, empiric and diagnostic-driven antifungal strategies, treatment of yeast, invasive mould and Pneumocystis jirovecii infection.…”