Skip main navigation

How do we diagnose Candidaemia? – Part 1

Case study 2: disseminated candida. How do we diagnose Candidaemia? This article begins to show the different methods.
© BSAC
Part of the challenge that fungal infections pose is that confirming a diagnosis can be difficult.
If candidaemia is suspected, empirical treatment is indicated. This principle is based on the absence of rapid sensitive and specific diagnostic tests and on the knowledge that every 24-hours of delay in starting effective treatment increases the mortality to candidaemia by up to 15%. It is not appropriate to wait for the blood culture to turn positive 24-36 hours later.
What antifungal stewardship approaches could be used to prevent overuse of antifungals in the ICUs? What diagnostics are available and how should these be used?

Blood Culture

candida seen under the microscope using a blue stain
Blood culture remains the gold standard for the diagnosis of candidaemia but its sensitivity is considerably lower than in common bacteraemia due to low concentration of Candida in blood (up to 65% of positive blood cultures have <1 CFU/ml).

Antifungal Susceptibility Testing

antifungal susceptibility testing of candida on an agar plate. Zones of inhibition seen around diffusion disc and MIC strip
Antifungal susceptibility testing of Candida species may be done using standard platforms used for antibiotic susceptibility testing (VITEK).
  • Antifungal susceptibility testing is available at the two national mycology reference laboratories (PHE and NHS), results are available in 3-4 days

Candida Score

Recording the number of body sites colonised with Candida has been used to assess the risk for candidaemia (Candida score). However, it is important to understand that colonisation as such should not be treated with antifungals. Instead, it should trigger infection prevention measures such as changing urinary caterers (in case of high Candida counts in urine), change of lines (in case of heavy Candida growth around peripheral line) or improvement of oral hygiene/change of endotracheal tube (in case of heavy Candida growth in respiratory samples).
© BSAC
This article is from the free online

The Role of Antifungal Stewardship

Created by
FutureLearn - Learning For Life

Our purpose is to transform access to education.

We offer a diverse selection of courses from leading universities and cultural institutions from around the world. These are delivered one step at a time, and are accessible on mobile, tablet and desktop, so you can fit learning around your life.

We believe learning should be an enjoyable, social experience, so our courses offer the opportunity to discuss what you’re learning with others as you go, helping you make fresh discoveries and form new ideas.
You can unlock new opportunities with unlimited access to hundreds of online short courses for a year by subscribing to our Unlimited package. Build your knowledge with top universities and organisations.

Learn more about how FutureLearn is transforming access to education