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
