Fungemia: Difference between revisions

Revision as of 09:52, 25 August 2020

Background

Systemic infection with a Candida species

Microbiology

Candida albicans (46%)
Candida glabrata (26%)
Candida parapsilosis (16%)
Candida tropicalis (8%)
Candida krusei (3%)
Candida 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 perforation

Clinical Manifestations

Positive blood culture for a Candida species
Fever
Triad of bowel perforation, increase white cell count, and decreased platelets
Can be complicated by endophthalmitis

Investigations

Blood cultures
Blood count (increased WBCs, decreased platelets)
Consider 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.
^ lashof2011oc

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+== Background ==
-* Systemic infection with a [[Candida species]]
+*Systemic infection with a [[Candida species]]
-== Etiology ==
+===Microbiology===
-* ''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 https://doi.org/10.1086/599039]
+*[[Candida albicans]] (46%)
-== Risk Factors ==
+*[[Candida glabrata]] (26%)
+*[[Candida parapsilosis]] (16%)
+*[[Candida tropicalis]] (8%)
+*[[Candida krusei]] (3%)
+*[[Candida 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
+*Immune-compromised
-== Clinical Manifestations ==
+*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 perforation]]
+==Clinical Manifestations==
-* Positive blood culture for Candida spp.
-* Fever
-* Triad of bowel perforation, increase white cell count, and decreased platelets
+*Positive blood culture for a [[Candida species]]
-== Investigations ==
+*Fever
+*Triad of bowel perforation, increase white cell count, and decreased platelets
+*Can be complicated by [[endophthalmitis]]
+==Investigations==
-* Blood culture
-* Blood count (increased WBCs, decreased platelets)
-* Echo to rule out endocarditis
+*Blood cultures
-== Management ==
+*Blood count (increased WBCs, decreased platelets)
+*Consider 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
+*'''Never treat as a contaminant!'''
-* Antifungal therapy
+*'''Requires ophthalmology consult''' to rule out [[endophthalmitis]], ideally around 1 week after positive cultures
-** First-line (stable patients): fluconazole if no risk factors for a resistant species
+*Antifungal therapy
-** Alternative (resistance or septic): micafungin or another echinocandin
+**First-line (stable patients): [[fluconazole]] if no risk factors for a resistant species
-** Alternative (last-line): amphotericin B
+**Alternative (resistance or septic): [[micafungin]] or another [[echinocandin]]
+**Alternative (last-line): [[amphotericin B]]
 [[Category:Yeasts]]