Prognosis

Attributable mortality to candidaemia ranges from 5% to 70%.[85]​ The following factors have been shown to influence that rate:

  • Clinical specifics related to the invasive Candida process (such as the presence of complications [e.g., endocarditis, central nervous system disease, septic shock]).

  • Host factors: acute physiology and chronic health evaluation (APACHE II score), neutropenia, and comorbidity, including underlying diseases (e.g., malignancy, diabetes mellitus, and other immunosuppressive disease and therapy).

  • Candida species responsible: for example, Candida parapsilosis is usually an intravascular catheter-related pathogen that has lower morbidity and mortality. In contrast, a higher mortality has been attributed to Candida tropicalis, Candida glabrata, and Candida auris.[86][87][88]​​​[89]

  • Timing and appropriateness of the antifungal therapy. Delay in therapy may increase mortality,​​ with increased mortality associated with number of days that passed following notification of positive blood cultures for yeast.[61][62] Other factors include retention of a central venous culture and inadequate fluconazole dosing.[90]

Recognising the importance of avoiding delay in instituting appropriate antifungal therapy, the Infectious Diseases Society of America has advised consideration for the early empirical use of broad-spectrum antifungal drugs (e.g., echinocandins) in febrile, non-neutropenic, high-risk intensive care unit patients failing to defervesce upon receipt of antibacterial agents, especially when cause of fever or sepsis is unknown.[32]

One multi-centre observational study of candidaemia including hospitals from 20 European countries demonstrated an overall 90-day mortality due to candidaemia of 43%, with overall attributable mortality of 37%. The study highlighted that adherence to Infectious Diseases Society of America or European Society of Clinical Microbiology and Infectious Diseases guidelines measured by the EQUAL Candida score was a strong independent predictor of survival. Following society guidelines in diagnosis and treatment remains key in successful management of patients with candidaemia.[91]

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