{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:33:43Z","timestamp":1786113223620,"version":"build-2736575974"},"reference-count":192,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T00:00:00Z","timestamp":1783728000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Candidemia remains associated with substantial morbidity and mortality despite advances in antifungal therapy, yet multiple aspects of management remain controversial. This review synthesizes emerging evidence to address unresolved clinical dilemmas in candidemia management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>This publication reviews data on optimized antifungal dosing, rapid diagnostic tests (RDTs), antifungal susceptibility testing (AFST), echinocandin-to-azole transition, treatment duration, ophthalmologic screening, echocardiographic evaluation, Candida endocarditis, the place in therapy of rezafungin, antifungal resistance, and dosing considerations in children. Substantial pharmacokinetic variability in critically ill and obese patients supports individualized dosing strategies to reduce underexposure. Echinocandin-to-azole transition after 3 to 5 days appears safe in clinically stable patients with bloodstream sterilization and predicted or confirmed azole susceptibility. Although the standard 14-day duration remains a guideline-supported recommendation, emerging evidence suggesting shorter durations may be feasible in carefully selected patients with truly uncomplicated candidemia. Risk-based approaches to ophthalmologic screening and echocardiography may improve diagnostic stewardship while reducing unnecessary testing. Echinocandins appear at least as effective and safer than amphotericin B for Candida endocarditis. Rezafungin offers a practical once-weekly alternative for select patients requiring prolonged intravenous therapy, although evidence for deep-seated infection remains limited. Increasing resistance among non-albicans Candida species, particularly C. parapsilosis, C. glabrata, and C. auris further reinforces the importance of AFST and ongoing surveillance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Optimal candidemia management increasingly depends on individualized antifungal strategies, integration of RDTs and AFST, earlier species-directed therapy transitions, and selective evaluation for metastatic complications. Future studies are needed to better define uncomplicated candidemia, optimize treatment duration, and address evolving antifungal resistance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajhp\/zxag212","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T08:30:24Z","timestamp":1783758624000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinical controversies in the management of candidemia in adults and children"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3656-1144","authenticated-orcid":false,"given":"David B","family":"Cluck","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University , Johnson City, TN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5657-7069","authenticated-orcid":false,"given":"Bryan P","family":"White","sequence":"additional","affiliation":[{"name":"University of Oklahoma Medical Center , Oklahoma City, OK ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8501-2142","authenticated-orcid":false,"given":"Sarah A","family":"Hilzendager","sequence":"additional","affiliation":[{"name":"University of Oklahoma College of Pharmacy , Oklahoma City, OK ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan H","family":"Ryder","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center , Omaha, NE ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4782-1538","authenticated-orcid":false,"given":"Patrick J","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Charlie Norwood VA Medical Center , Augusta, GA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8944-028X","authenticated-orcid":false,"given":"Amanda Z","family":"McPherson","sequence":"additional","affiliation":[{"name":"University of Georgia College of Pharmacy , Augusta, GA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3968-6074","authenticated-orcid":false,"given":"Daniel J","family":"Rogers","sequence":"additional","affiliation":[{"name":"Emory Decatur Hospital , Decatur, GA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4018-0195","authenticated-orcid":false,"given":"Daniel B","family":"Chastain","sequence":"additional","affiliation":[{"name":"University of Georgia College of Pharmacy , Augusta, GA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,11]]},"reference":[{"key":"2026080513514764800_zxag212-B1","author":"Centers for Disease Control and Prevention"},{"issue":"4","key":"2026080513514764800_zxag212-B2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss7404a1","article-title":"Population-based active surveillance for culture-confirmed candidemia\u201410 sites, United States, 2017-2021","volume":"74","author":"Jenkins","year":"2025","journal-title":"MMWR Surveill Summ"},{"issue":"3","key":"2026080513514764800_zxag212-B3","doi-asserted-by":"crossref","first-page":"106229","DOI":"10.1016\/j.jinf.2024.106229","article-title":"Attributable mortality of candidemia\u2014results from the ECMM Candida III multinational European observational cohort study","volume":"89","author":"Salmanton-Garcia","year":"2024","journal-title":"J Infect"},{"key":"2026080513514764800_zxag212-B4","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciag312","article-title":"Changes in epidemiology of candidemia in the United States with a focus on Candida auris","volume":"11","author":"P\u00e9rez","year":"2026","journal-title":"Clin Infect Dis. 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