Optimal duration of antifungal therapy in candidemia.

IF 3.4 3区医学 Q1 CRITICAL CARE MEDICINE

Current Opinion in Critical Care Pub Date : 2025-10-01 Epub Date: 2025-09-04 DOI:10.1097/MCC.0000000000001308

Claudia Bartalucci, Antonio Vena, Matteo Bassetti

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引用次数: 0

Abstract

Purpose of review: In candidemia, the standard 14-day antifungal treatment after blood culture clearance has been long accepted, despite being based on limited and outdated evidence. This review discusses the rationale for re-evaluating treatment duration, in the context of growing interest in optimizing antifungal use.

Recent findings: A small number of retrospective studies have explored shorter treatment courses in uncomplicated candidemia, suggesting similar outcomes in terms of mortality and recurrence compared to the traditional 14-day regimen. However, these data are limited and potentially biased, with no randomized controlled trials available to provide definitive guidance. Moreover, no validated clinical, microbiological, or biomarker-based algorithms currently exist to inform individualized treatment duration in daily practice.

Summary: The historical 14-day rule for candidemia treatment is increasingly challenged by recent literature, yet the available evidence remains scarce and methodologically limited. A well designed randomized controlled trial is urgently needed to establish the efficacy and safety of shorter antifungal courses. These data would be essential to inform clinical decisions and support antifungal stewardship by minimizing unnecessary treatments, lowering costs, limiting resistance, and improving patient outcomes.

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念珠菌病抗真菌治疗的最佳持续时间。

综述目的：在念珠菌中，尽管基于有限和过时的证据，但血液培养清除后标准的14天抗真菌治疗已被长期接受。这篇综述讨论了重新评估治疗时间的基本原理，在优化抗真菌药物使用的背景下。近期发现：少数回顾性研究探索了简单念珠菌的较短治疗疗程，与传统的14天治疗方案相比，在死亡率和复发率方面的结果相似。然而，这些数据是有限的，并且可能存在偏差，没有随机对照试验可以提供明确的指导。此外，目前还没有经过验证的临床、微生物学或基于生物标志物的算法来告知日常实践中个性化治疗的持续时间。摘要：念珠菌治疗的历史14天规则越来越受到近期文献的挑战，但现有证据仍然很少，方法上也有限。迫切需要一项设计良好的随机对照试验来确定短期抗真菌疗程的有效性和安全性。这些数据对于通过减少不必要的治疗、降低成本、限制耐药性和改善患者预后来告知临床决策和支持抗真菌管理至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Critical Care 医学-危重病医学

CiteScore

5.90

自引率

3.00%

发文量

172

审稿时长

6-12 weeks

期刊介绍： Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.