Fungemia: Difference between revisions
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* Systemic infection with a [[Candida species]] |
* Systemic infection with a [[Candida species]] |
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= Etiology = |
== Etiology == |
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* ''C. albicans'' (46%) |
* ''C. albicans'' (46%) |
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* Numbers based on [https://doi.org/10.1086/599039 https://doi.org/10.1086/599039] |
* Numbers based on [https://doi.org/10.1086/599039 https://doi.org/10.1086/599039] |
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= Risk Factors = |
== Risk Factors == |
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* Immune-compromised |
* Immune-compromised |
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* Gastrointestinal perforations |
* Gastrointestinal perforations |
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= Presentation = |
== Presentation == |
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* Positive blood culture for Candida spp. |
* Positive blood culture for Candida spp. |
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* Triad of bowel perforation, increase white cell count, and decreased platelets |
* Triad of bowel perforation, increase white cell count, and decreased platelets |
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= Investigations = |
== Investigations == |
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* Blood culture |
* Blood culture |
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* Echo to rule out endocarditis |
* Echo to rule out endocarditis |
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= Management = |
== Management == |
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* '''Never treat as a contaminant!''' |
* '''Never treat as a contaminant!''' |
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Revision as of 19:48, 15 August 2019
- Systemic infection with a Candida species
Etiology
- C. albicans (46%)
- C. glabrata (26%)
- C. parapsilosis (16%)
- C. tropicalis (8%)
- C. krusei (3%)
- C. auris (rare): growing concern for multidrug resistance
- Numbers based on https://doi.org/10.1086/599039
Risk Factors
- Immune-compromised
- Long-term and broad-spectrum antibiotic use, especially in ICU
- Multiple or long-term IV lines, central lines, etc.
- Total parenteral nutrition
- Acute kidney injury, especially requiring dialysis
- Abdominal surgery
- Gastrointestinal perforations
Presentation
- Positive blood culture for Candida spp.
- Fever
- Triad of bowel perforation, increase white cell count, and decreased platelets
Investigations
- Blood culture
- Blood count (increased WBCs, decreased platelets)
- Echo to rule out endocarditis
Management
- Never treat as a contaminant!
- Requires ophthalmology consult to rule out endophthalmitis, ideally around 1 week after positive cultures
- Antifungal therapy
- First-line (stable patients): fluconazole if no risk factors for a resistant species
- Alternative (resistance or septic): micafungin or another echinocandin
- Alternative (last-line): amphotericin B
References
- a b Andre N. Sofair, G. Marshall Lyon, Sharon Huie‐White, Errol Reiss, Lee H. Harrison, Laurie Thomson Sanza, Beth A. Arthington‐Skaggs, Scott K. Fridkin. Epidemiology of Community‐Onset Candidemia in Connecticut and Maryland. Clinical Infectious Diseases. 2006;43(1):32-39. doi:10.1086/504807.
