{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:06:30Z","timestamp":1789725990073,"version":"4.0.1"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>A recent proposal introduced criteria to distinguish uncomplicated from complicated candidemia and identify patients who might be candidates for a shortened (7-day) course of antifungal therapy. We evaluated the feasibility and potential impact of this strategy in a real-world cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included patients with candidemia at Lausanne University Hospital (2015\u20132024). We estimated the sample size required for a randomized non-inferiority trial comparing 7 vs 14 days of therapy for episodes with uncomplicated candidemia and the reduction in antifungal treatment days under a hypothetical 7-day treatment strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 314 episodes of candidemia, 103 (33%) were classified as uncomplicated. Of the 264 (84%) episodes surviving beyond the first 5 days without limitation of care, 30-day mortality was lower in uncomplicated than complicated candidemia (7% vs 20%; P = .006). Based on a hypothetical randomized non-inferiority trial comparing 7 vs 14 days of antifungal therapy, assuming an expected event rate of 25% and a non-inferiority margin of 7.5%, 1103 patients would be required. Overall, the 314 episodes received 6377 days of antifungal therapy (median, 14 days; interquartile range 13\u201318). A shortened 7-day treatment strategy for uncomplicated candidemia would have reduced antifungal exposure by 799 treatment days, corresponding to a 13% reduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Uncomplicated candidemia accounted for only one-third of episodes, and abbreviated therapy would yield a modest reduction in antifungal exposure. The large sample size required and limited stewardship benefit suggest that a randomized trial would be challenging to conduct.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag530","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:49:55Z","timestamp":1787312995000},"source":"Crossref","is-referenced-by-count":0,"title":["Challenging the Concept of Uncomplicated Candidemia for Shorter Courses of Antifungal Therapy"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0565-5105","authenticated-orcid":false,"given":"Matthaios","family":"Papadimitriou-Olivgeris","sequence":"first","affiliation":[{"name":"Infectious Diseases Service, Lausanne University Hospital , Lausanne ,","place":["Switzerland"]},{"name":"Infectious Diseases Service, Institut Central des H\u00f4pitaux and Hospital of Valais , Sion ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Senn","sequence":"additional","affiliation":[{"name":"Infectious Diseases Service, Lausanne University Hospital , Lausanne ,","place":["Switzerland"]},{"name":"Infection Prevention and Control Unit, Lausanne University Hospital , Lausanne ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alix","family":"Coste","sequence":"additional","affiliation":[{"name":"Institute of Microbiology, Lausanne University Hospital and University of Lausanne , Lausanne ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1023-5597","authenticated-orcid":false,"given":"Fr\u00e9d\u00e9ric","family":"Lamoth","sequence":"additional","affiliation":[{"name":"Infectious Diseases Service, Lausanne University Hospital , Lausanne ,","place":["Switzerland"]},{"name":"Institute of Microbiology, Lausanne University Hospital and University of Lausanne , Lausanne ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"key":"2026091805315228400_ofag530-B1","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1007\/s10096-007-0383-4","article-title":"Use of the PATH Alliance database to measure adherence to IDSA guidelines for the therapy of candidemia","volume":"26","author":"Horn","year":"2007","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2026091805315228400_ofag530-B2","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofac656","article-title":"Short course of antifungal therapy in patients with uncomplicated Candida bloodstream infection: another case of less is more in the clinical setting?","volume":"10","author":"Vena","year":"2023","journal-title":"Open Forum Infect Dis"},{"key":"2026091805315228400_ofag530-B3","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1016\/S1473-3099(19)30405-0","article-title":"Effect of infectious disease consultation on mortality and treatment of patients with candida bloodstream infections: a retrospective, cohort study","volume":"19","author":"Mejia-Chew","year":"2019","journal-title":"Lancet Infect Dis"},{"key":"2026091805315228400_ofag530-B4","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofac383","article-title":"Key role of early source control in candidemic patients with sepsis or septic shock","volume":"9","author":"Papadimitriou-Olivgeris","year":"2022","journal-title":"Open Forum Infect Dis"},{"key":"2026091805315228400_ofag530-B5","doi-asserted-by":"crossref","first-page":"e280","DOI":"10.1016\/S1473-3099(24)00749-7","article-title":"Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM","volume":"25","author":"Cornely","year":"2025","journal-title":"Lancet Infect Dis"},{"key":"2026091805315228400_ofag530-B6","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2026091805315228400_ofag530-B7","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1056\/NEJM199411173312001","article-title":"A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. 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