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European Committee on Antimicrobial Susceptibility Testing and Clinical and Laboratory Standards Institute breakpoints-the only point that matters in candidemia?

Candidemia is associated with high mortality of around 46.9% (1). Risk factor for candidemia are sepsis, Clostridium difficile infection, diabetes mellitus, total parenteral nutrition, chronic obstructive pulmonary disease, presence of peripherally inserted central catheter, previous antibiotic therapy and immunosuppressive therapy (2). Treatment of candidemia should be guided by local epidemiology and sensitivity pattern. To point out the difference, Candida albicans is the predominant candida isolated in Australia, Japan, Korea, Hong Kong, Malaysia, Singapore and Thailand whereas in Pakistan and India C. tropicalis is the most frequently encountered species (3). The IDSA recommends using echinocandins for candidemia and fluconazole for step down therapy or fluconazole in patients with low risk of resistant organism (4).