01Approach to the Critical Patient/attcp31

Immediate stabilization

›Septic shock recognition

›MAP < 65 mmHg despite adequate fluid resuscitation

›Vasopressor requirement to maintain MAP

›Lactate >= 2 mmol/l

›Initiate norepinephrine 0.01–0.5 mcg/kg/min IV, titrate to MAP >= 65 mmHg

›Antifungal urgency

›Echinocandin within 1 hour for septic shock with candidemia risk factors

›Delay > 24 hours associated with near-100% mortality in septic shock

›Do not wait for culture confirmation before initiating therapy in the critically ill

›Airway and oxygenation

›SpO2 target >= 92%

›Supplemental oxygen titration

›Intubation if respiratory failure secondary to metastatic pneumonia or sepsis

Monitoring and escalation

›Escalation triggers

›Persistent fever > 72 hours on appropriate antifungal therapy

›Reassess for source, repeat cultures, imaging for deep-seated foci

›Positive blood cultures > 5 days on therapy

›Suggests uncontrolled source, endovascular infection, or deep-seated candidiasis

›New visual symptoms

›Emergent ophthalmology consult for endophthalmitis

›New cardiac murmur or embolic phenomena

›Urgent echocardiography, cardiology consult

›Monitoring bundle

›Blood cultures every 24–48 hours until documented clearance

›Repeat electrolytes, creatinine, LFTs every 48 hours on antifungals

›QTc monitoring if transitioning to azoles

02History/hx47

Presenting symptoms

›Fever phenotype

›Fever unresponsive to broad-spectrum antibiotics — most common presentation

›Rigors, chills

›Hemodynamic instability disproportionate to apparent bacterial source

›Ophthalmologic symptoms

›Blurred vision

›Floaters

›Eye pain or photophobia

›Screen all patients — endophthalmitis complicates 1.8–10% of candidemia cases

›Metastatic symptoms

›Back or vertebral pain (osteomyelitis)

›Joint pain or swelling (septic arthritis)

›Abdominal pain (intra-abdominal abscess, hepatosplenic candidiasis)

›Flank pain or dysuria (renal abscess)

›New cardiac murmur or pleuritic chest pain (endocarditis)

›Headache or altered mental status (CNS involvement)

Risk factors

›Healthcare exposure risk factors

›Central venous catheter — present in 64–73% of candidemia cases

›ICU admission — 50–67% of candidemia cases occur in ICU

›Prior or current broad-spectrum antibiotic exposure — present in 77–81% of cases

›Total parenteral nutrition (TPN)

›Recent surgery, especially abdominal, GI, or thoracic

›Renal replacement therapy or acute kidney injury

›Prior antifungal therapy (raises resistance concern)

›Patient-level risk factors

›Malignancy — hematologic or solid organ (~37–39% of candidemia cases)

03Physical Exam/exam33

Vital signs

›Hemodynamic status

›Temperature — fever may be absent in immunosuppressed or neutropenic patients

›Heart rate — tachycardia

›Blood pressure — hypotension as septic shock marker

›Respiratory rate — tachypnea from sepsis or pulmonary metastatic involvement

›SpO2

›MAP < 65 mmHg — ICU-level care trigger

Targeted organ exam

›Ophthalmologic exam

›Dilated fundoscopic examination

›Fluffy white chorioretinal lesions — pathognomonic for ocular candidiasis

›Vitreal extension — endophthalmitis pattern

›Sensitivity for detection higher when performed > 7 days from first positive culture

›Cardiovascular exam

›Auscultation for new or changing murmur

›Endocarditis found in ~11% of candidemia patients undergoing echocardiography

›Peripheral stigmata of endocarditis (Osler nodes, Janeway lesions, splinter hemorrhages)

›Skin exam

›Erythematous papular or nodular lesions on trunk and extremities

›Disseminated cutaneous candidiasis pattern

›CVC insertion site — erythema, warmth, purulence, tenderness

›Abdominal exam

›Tenderness — hepatosplenic or intra-abdominal candidiasis

›Peritoneal signs — perforation or abscess

›Hepatosplenomegaly

›Musculoskeletal exam

›Vertebral point tenderness (osteomyelitis)

04Differential Diagnosis/ddx30

Life-threatening mimics

›Bacterial bloodstream infection / sepsis

›Most common mimic — coexists with candidemia in ~20% of cases

›ICD-10: A41.9 (Sepsis, unspecified organism)

›Blood cultures with gram stain and sensitivities required to differentiate

›Infective endocarditis (bacterial)

›ICD-10: I33.0

›Consider if persistent bacteremia, new murmur, embolic events

›Aspergillosis or mucormycosis

›ICD-10: B44.1, B46.5

›Neutropenic and transplant patients at highest risk

›Galactomannan and CT chest distinguish aspergillosis

Healthcare-associated infections

›Catheter-related bloodstream infection (non-Candida)

›ICD-10: T82.7XXA

›Similar risk factors — CVC, ICU, broad-spectrum antibiotics

›Intra-abdominal abscess (bacterial)

›ICD-10: K65.1

›Especially post-surgical — CT-guided drainage and cultures required

›Clostridioides difficile infection

›ICD-10: A04.71

›Antibiotic-associated, fever and leukocytosis without clear source

Other considerations

›Drug fever

›Diagnosis of exclusion — temporal relationship with new medication

›Rash, eosinophilia may be present

›Candida auris bloodstream infection

›ICD-10: B37.7 (Candida septicemia)

05Laboratory Tests/lt42

Blood cultures

›Blood culture collection

›Gold standard for candidemia diagnosis

›Minimum 2–3 sets (40–60 mL total blood volume) from separate venipunctures

›Sensitivity 60–90%; specificity near 100%

›Time to positivity typically 1–7 days — slower for Candida than bacteria

›Repeat cultures every 24–48 hours until documented clearance (IDSA Class I)

Molecular and biomarker testing

›Beta-D-glucan (BDG)

›Sensitivity 50–90%, specificity 70–100%

›High negative predictive value — useful for ruling out in low-risk patients

›False positives with IVIG, albumin, beta-lactams, hemodialysis membranes, gauze

›Adjunct only — not diagnostic alone (IDSA Level B evidence)

›T2Candida panel

›Sensitivity ~90%, specificity > 95%

›Turnaround 4–5 hours — significantly faster than culture

›Detects C. albicans, C. tropicalis, C. parapsilosis, C. glabrata, C. krusei

›Does not replace blood cultures for susceptibility testing

›Candida PCR

›Sensitivity 90–95%, specificity > 90%

›Limited standardization across laboratories

›May detect candidemia when cultures are negative

Antifungal susceptibility

›Susceptibility testing

›Strongly recommended for all Candida bloodstream isolates (IDSA Class I)

›MALDI-TOF mass spectrometry for rapid species identification from positive cultures

›Echinocandin resistance most common in C. glabrata (Nakaseomyces glabrata)

›Fluconazole resistance: C. krusei (intrinsically resistant), C. glabrata (emerging)

06Diagnostic Tests/dt47

Scoring Systems

›Candida Score (ICU risk stratification)

›Components: surgery (+1), TPN (+1), multifocal Candida colonization (+1), severe sepsis (+2)

›Score >= 3 identifies ICU patients at high risk for invasive candidiasis

›Sensitivity ~78%, specificity ~66% for invasive candidiasis in ICU

›Used to guide empiric antifungal initiation decisions

›EQUAL Candida Score (guideline adherence)

›Measures adherence to ECMM/ISHAM guideline recommendations

›Each point decrease in adherence score associated with 8–9% increased mortality

›Domains: antifungal selection, ophthalmologic exam, echocardiography, CVC removal, follow-up cultures

›APACHE II score

›Increasing APACHE II — independent predictor of candidemia mortality

›Used for ICU risk stratification and mortality estimation

›Pitt Bacteremia Score

›Adapted for candidemia prognostication in non-ICU patients

›Score >= 4 associated with significantly increased mortality

MRI

›MRI indications in candidemia

›MRI brain — suspected CNS candidiasis (altered mental status, focal deficits)

›Microabscesses appear as small enhancing lesions on T1 post-gadolinium

›Meningeal enhancement in Candida meningitis

›MRI spine — vertebral osteomyelitis or epidural abscess

›T2 hyperintensity in involved disc and vertebral bodies

›Post-gadolinium T1 for extent of epidural involvement

›MRI liver and spleen — hepatosplenic candidiasis (chronic disseminated)

›Bull's-eye or target lesions on T2-weighted sequences

›Typically occurs during neutrophil recovery phase

›MRI superior to CT for soft tissue and CNS involvement characterization

07Disposition/dispo31

Admission criteria

›All candidemia patients require hospital admission

›IV antifungal therapy mandatory — no outpatient oral-only regimen for candidemia

›Source control requiring procedural or surgical intervention

›Monitoring for metastatic complications

›ICU admission indications

›Septic shock (vasopressor requirement, MAP < 65 mmHg)

›Multiorgan dysfunction

›Respiratory failure

›Rapidly worsening clinical status

Consultation and specialist involvement

›Infectious diseases consultation

›Associated with improved survival (HR 0.81) — strongly recommended for all cases

›Guides antifungal selection, duration, and step-down decisions

›Ophthalmology consultation

›Dilated fundoscopic exam within first week for all non-neutropenic patients (IDSA Class I)

›Repeat exam if initial exam performed < 7 days from first positive culture

›Cardiology or cardiac surgery — confirmed or suspected endocarditis

›Neurosurgery — CNS involvement with abscess amenable to drainage

›Interventional radiology — percutaneous drainage of accessible abscesses

Step-down and discharge planning

›Criteria for step-down from IV echinocandin to oral fluconazole

›Hemodynamically stable

›Blood cultures documented negative

›Fluconazole-susceptible isolate confirmed

›Source controlled (CVC removed, abscess drained)

›Non-neutropenic

›Tolerating oral medications

08Treatment/t67

Antifungal therapy — first-line

›Echinocandins (first-line for all candidemia, IDSA/ECMM/ISHAM Class I)

›Caspofungin IV

›Loading dose: 70 mg IV once

›Maintenance: 50 mg IV daily

›Hepatic adjustment: reduce maintenance to 35 mg daily for Child-Pugh B/C

›Micafungin IV

›100 mg IV daily (no loading dose required)

›Dose 150 mg IV daily for neutropenic patients or suspected less-susceptible species

›Anidulafungin IV

›Loading dose: 200 mg IV once

›Maintenance: 100 mg IV daily

›Rezafungin IV (strongly recommended, 2025 ECMM guideline)

›Loading dose: 400 mg IV on day 1

›Maintenance: 200 mg IV weekly

›Advantage: once-weekly dosing

›Treatment duration: 14 days from first negative blood culture (IDSA Class I)

Antifungal therapy — alternatives

›Fluconazole IV or oral

›Loading dose: 800 mg (12 mg/kg) IV or PO once

›Maintenance: 400 mg (6 mg/kg) daily

›Reserved for: non-critically ill, hemodynamically stable, fluconazole-susceptible isolate, no prior azole exposure

›Not for empiric use in ICU or critically ill patients

›Step-down from echinocandin at day 5–7 if all criteria met

›Liposomal amphotericin B

›3–5 mg/kg IV daily

›For azole- and echinocandin-resistant strains

›Monitor renal function — less nephrotoxic than conventional amphotericin B deoxycholate

›Conventional amphotericin B deoxycholate not recommended due to nephrotoxicity (IDSA Class III)

›Voriconazole

›Loading: 6 mg/kg IV every 12 hours x 2 doses

›Maintenance: 4 mg/kg IV every 12 hours; transition to 200 mg PO every 12 hours

›Preferred for step-down when mold coverage also needed

›Drug of choice for ocular candidiasis — better intraocular penetration than echinocandins

Source control

›Central venous catheter (CVC) removal

›Remove all CVCs as soon as feasible — IDSA Class I, strongly recommended

›CVC retention associated with longer candidemia duration and higher mortality

›If CVC cannot be removed (hemodialysis catheter, no other access), antifungal lock therapy may be considered as adjunct

›Surgical and interventional source control

›Drainage of intra-abdominal abscesses

›Management of anastomotic leaks

›Removal of infected prosthetic material when feasible

Metastatic complication management

›Endophthalmitis management

›Switch from echinocandin to fluconazole 400–800 mg daily or voriconazole

›Echinocandins have inadequate intraocular penetration

›Duration: minimum 4–6 weeks for chorioretinitis without vitreal involvement

›Intravitreal amphotericin B 5–10 mcg in 0.1 mL or voriconazole 25–100 mcg in 0.1 mL

›Vitrectomy if vitreal opacity or retinal detachment threat

›Endocarditis management

›Liposomal amphotericin B 3–5 mg/kg daily or echinocandin as initial therapy

›Cardiac valve surgery strongly recommended — medical management alone has high failure rate

›Duration: minimum 6 weeks after valve replacement, longer for native valve

›Fluconazole suppressive therapy after completion for select patients at high relapse risk

›CNS candidiasis

›Liposomal amphotericin B 5 mg/kg daily + flucytosine 25 mg/kg PO four times daily

›Step-down to fluconazole 400–800 mg daily once stable

›Duration: minimum 4 weeks after last positive CSF culture and symptom resolution

›Vertebral osteomyelitis / septic arthritis

›Fluconazole 400 mg daily after initial echinocandin therapy

›Duration: minimum 6–12 months

›Surgical debridement if spinal instability or neurologic compromise

Hemodynamic and supportive care

›Sepsis resuscitation

›Crystalloid resuscitation 30 mL/kg IV for hypoperfusion within first 3 hours

›Norepinephrine 0.01–0.5 mcg/kg/min — first-line vasopressor for septic shock

›Vasopressin 0.03 units/min additive for refractory shock

›Hydrocortisone 200 mg/day IV for vasopressor-refractory shock

›Nutrition optimization

›Transition from TPN to enteral nutrition when feasible — reduces candidemia risk

›Adequate protein and caloric support for immune recovery

09Special Populations/sp58

Pregnancy

›Epidemiology in pregnancy

›Candidemia uncommon in uncomplicated pregnancy — most cases in ICU or post-surgical settings

›Candidemia in pregnancy associated with preterm delivery, fetal loss, and neonatal candidiasis

›Mucosal candidiasis (vulvovaginal) extremely common; does not require systemic therapy

›Antifungal safety

›Fluconazole — contraindicated in first trimester (teratogenic, associated with cardiac septal defects and craniosynostosis at doses >= 150 mg)

›Fluconazole single-dose 150 mg in first trimester has uncertain risk — avoid if possible

›Echinocandins — limited human data; animal data show fetal harm at high doses; used when benefit outweighs risk in severe invasive candidemia

›Liposomal amphotericin B — preferred agent in pregnancy for invasive candidiasis

›3–5 mg/kg IV daily

›Monitor for maternal nephrotoxicity and electrolyte disturbances

›Azoles (voriconazole, posaconazole, itraconazole) — contraindicated in pregnancy

›Monitoring

›Fetal monitoring throughout treatment

›Maternal renal function with amphotericin B

›Obstetric and maternal-fetal medicine consultation

Geriatric

›Epidemiology and risk

›Incidence increases with age — peak incidence in patients > 65 years

›Higher crude in-hospital mortality (approaching 50% in > 75 years)

›Greater prevalence of comorbidities: diabetes, CKD, malignancy, CHF

›Clinical presentation differences

›Fever may be blunted or absent

›Altered mental status as predominant presenting feature

›Higher likelihood of atypical or nonspecific presentation

›Pharmacologic considerations

›Echinocandins — no dose adjustment required for age alone; preferred first-line

›Fluconazole — renal dose adjustment if eGFR < 50 mL/min/1.73m2

›Reduce dose by 50% for severe renal impairment

›Amphotericin B — nephrotoxicity risk amplified in elderly with baseline CKD

›Monitor for drug interactions — polypharmacy common; azoles inhibit CYP3A4 and CYP2C9

›QTc prolongation risk with azoles in patients on other QT-prolonging medications

›Source control

›CVC removal may require careful assessment of access alternatives

›Higher surgical risk — multidisciplinary risk-benefit assessment for valve surgery

Pediatrics

›Epidemiology

›Neonates (especially premature < 29 weeks) at highest risk — incidence 1–10 per 1000 NICU admissions

›C. parapsilosis dominant species in neonates and children (catheter-associated)

›Pediatric candidemia incidence declining due to antifungal prophylaxis in NICU settings

›Children with hematologic malignancy or HCT also at high risk

›Neonatal candidemia

›Amphotericin B deoxycholate 1 mg/kg/day IV — first-line for neonates (CNS penetration superior)

›Liposomal amphotericin B 3–5 mg/kg/day IV — alternative, lower nephrotoxicity

›Fluconazole 12 mg/kg/day IV or PO (max 800 mg/day) — step-down or prophylaxis

›Echinocandins in neonates: use only when above agents failed or resistant — limited PK data

›Micafungin 4–10 mg/kg/day in neonates — limited but emerging evidence

›Pediatric (non-neonatal) candidemia

›Caspofungin 70 mg/m2 loading dose (max 70 mg), then 50 mg/m2 daily (max 50 mg)

›Micafungin 2–4 mg/kg/day (max 100 mg)

›Anidulafungin 1.5 mg/kg/day (max 100 mg)

›Fluconazole 6–12 mg/kg/day (max 400–800 mg) — for step-down

›Duration: 14 days from first negative blood culture (same as adults)

›Prophylaxis

›Fluconazole prophylaxis 3–6 mg/kg/day reduces candidemia in ELBW neonates

›Recommended in NICU units with incidence > 2 per 100 NICU admissions

›Per NIH/OAR pediatric OI guidelines (2025)

›Ophthalmologic screening

›Dilated exam indicated in pediatric candidemia — endophthalmitis can cause permanent vision loss

›Neonatal fundoscopy within first week of treatment

10Background/b66

Epidemiology

›Incidence and burden

›Most common healthcare-associated invasive fungal infection in the U.S. and Europe

›U.S. incidence: approximately 7–9 per 100,000 population

›Crude in-hospital mortality: 25–46%

›Attributable mortality: 10–20%

›Estimated 46,000 cases annually in the U.S. (pre-COVID era data)

›Species distribution (U.S. data 2017–2021)

›C. albicans: 37% (most common, generally fluconazole-susceptible)

›C. glabrata (Nakaseomyces glabrata): 30% — higher rates of fluconazole and echinocandin resistance

›C. parapsilosis: 14% — catheter-associated, echinocandin resistance emerging

›C. tropicalis: less common, associated with hematologic malignancy

›C. krusei (Pichia kudriavzevii): intrinsically fluconazole-resistant

›C. auris: 0.4% but rapidly increasing — often multidrug-resistant, nationally notifiable

›Population distribution

›50–67% of cases occur in ICU patients

›~37–39% in patients with malignancy

›~10% in persons who inject drugs (PWID) — increasing proportion

›Sex distribution: slightly male predominant

›Peak incidence: elderly (> 65 years) and neonates

›Temporal trends

›COVID-19 pandemic associated with increased candidemia incidence (2020–2021)

›C. auris rapid emergence since 2016 — now endemic in multiple U.S. states

›Echinocandin resistance rising, especially in C. glabrata

Pathophysiology

›Routes of infection

›Translocation from GI tract — most common route in ICU patients

›Mucosal disruption from surgery, chemotherapy, or critical illness

›Altered microbiome from broad-spectrum antibiotics permits Candida overgrowth

›Catheter-related infection

›Biofilm formation on catheter surfaces — Candida forms robust biofilms

›Luminal (hub contamination) or extraluminal (skin flora) routes

›Hematogenous seeding from primary mucosal or skin focus

›Virulence mechanisms

›Biofilm formation — dramatically reduces antifungal susceptibility (up to 1000-fold)

›Phenotypic switching between yeast and hyphal forms

›Secretion of hydrolases (phospholipases, proteinases) — tissue invasion

›Immune evasion via mannan and beta-glucan cell wall masking

›Metastatic seeding pattern

›Hematogenous dissemination to: eyes, heart valves, kidney, liver, spleen, bone, CNS

›Biofilm on damaged endothelium or prosthetic material

›Endophthalmitis via choroidal circulation — fundus lesions represent microabscesses

›Hepatosplenic candidiasis — occurs during neutrophil recovery, immune reconstitution

›Host defense failure

›Neutropenia — impairs killing of yeast and hyphae

›Defective monocyte/macrophage function — corticosteroids, transplant immunosuppression

›Disrupted mucosal barrier — surgery, chemotherapy, CVC

Therapeutic Considerations

›Antifungal pharmacology

›Echinocandins — inhibit (1,3)-beta-D-glucan synthase; fungicidal against Candida

›Minimal drug interactions — not CYP metabolized significantly

›Poor CNS and vitreous penetration — avoid if CNS or ocular candidiasis

›Hepatic metabolism — dose adjust in severe hepatic impairment (caspofungin)

›Azoles — inhibit ergosterol synthesis (CYP51/Erg11); fungistatic against Candida

›Major CYP3A4 interactions — warfarin, calcineurin inhibitors, statins

›QTc prolongation risk — baseline and monitoring ECG

›Good CNS and vitreous penetration — preferred for CNS and ocular candidiasis

›Amphotericin B — binds ergosterol, membrane disruption; fungicidal

›Nephrotoxicity — monitor creatinine, K+, Mg2+ closely

›Infusion reactions — premedication with acetaminophen, diphenhydramine

›Resistance considerations

›Echinocandin resistance — FKS gene mutations (FKS1, FKS2); especially C. glabrata

›Fluconazole resistance — ERG11 mutations, efflux pump upregulation

›C. auris — frequently resistant to fluconazole, amphotericin B; echinocandin-resistant strains reported

›Susceptibility testing guides therapy — MIC breakpoints per CLSI or EUCAST standards

›Guideline adherence and outcomes

›ECMM Candida III study: each point decrease in EQUAL Candida Score associated with 8–9% increased 30-day mortality

›Key adherence domains: ID consultation, echinocandin first-line, CVC removal, ophthalmologic exam, echocardiography, follow-up blood cultures

›Prophylaxis — fluconazole or micafungin prophylaxis recommended in high-risk surgical or NICU populations per IDSA guidelines

11Patient Discharge Instructions/pdi25

copy discharge instructions

›Discharge education for Candidemia

›You have been diagnosed with candidemia — a serious yeast (fungal) infection in your bloodstream

›You will need to continue antifungal medication by mouth (usually fluconazole) as prescribed

›Do not skip any doses — incomplete treatment can lead to relapse

›Take the full prescribed course even if you feel better

›Follow-up instructions

›See your doctor or infectious disease specialist within 1–2 weeks of discharge

›A repeat eye examination may be recommended if your initial eye exam was performed early in your illness

›Your doctor will order repeat blood tests and may check for recurrence

›Return to emergency department immediately if

›Fever above 38.0°C (100.4°F) returns or does not resolve

›Rigors or shaking chills

›New or worsening blurred vision, floaters, or eye pain

›Chest pain, new heart pounding, or palpitations

›Back pain, joint pain, or joint swelling

›Abdominal pain, nausea, or vomiting

›Confusion, new weakness, or difficulty speaking

›Skin rash or new lesions

›Any rapid deterioration in how you feel

›Lifestyle and prevention

›Intravenous lines increase infection risk — report any redness, swelling, or discharge at IV sites immediately

›Good hand hygiene reduces transmission risk — wash hands frequently

›Avoid unnecessary antibiotics — overuse contributes to fungal overgrowth

›If you use IV drugs, seek addiction medicine support — injection drug use is a major risk factor for candidemia recurrence

›Maintain blood sugar control if diabetic — hyperglycemia increases infection risk

12References/r55

Guidelines and key sources

›IDSA Clinical Practice Guideline for Candidiasis 2016

›Pappas PG, Kauffman CA, Andes DR, et al.

›Clinical Infectious Diseases 2016

›https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725385/

›ECMM/ISHAM/ASM Global Guideline for Candidiasis 2025

›Cornely OA, Sprute R, Bassetti M, et al.

›The Lancet Infectious Diseases 2025

›https://pubmed.ncbi.nlm.nih.gov/39956121

›ECMM Candida III Multinational Observational Cohort Study

›Hoenigl M, Salmanton-Garcia J, Egger M, et al.

›The Lancet Infectious Diseases 2023

›https://pubmed.ncbi.nlm.nih.gov/37254300

Epidemiologic surveillance

›U.S. Population-Based Active Surveillance 2017–2021

›Jenkins EN, Gold JAW, Benedict K, et al.

›MMWR Surveillance Summaries 2025

›https://pubmed.ncbi.nlm.nih.gov/40424200

›U.S. Population-Based Active Surveillance 2012–2016

›Toda M, Williams SR, Berkow EL, et al.

›MMWR Surveillance Summaries 2019

›https://pubmed.ncbi.nlm.nih.gov/31557145

Landmark reviews and trials

›Invasive Candidiasis — NEJM Review

›Kullberg BJ, Arendrup MC.

›New England Journal of Medicine 2015

›https://www.nejm.org/doi/full/10.1056/NEJMra1315399

›Risk Factors for Candidemia — Prospective Matched Case-Control

Evidence & Review

Evidence & Review