Fungemia: Difference between revisions
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==Background== |
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*Systemic infection with a [[Candida species]] |
*Systemic infection with a [[Candida species]] |
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===Risk Factors=== |
===Risk Factors=== |
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*Hospital-onset |
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*Immune-compromised |
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*Long-term and broad-spectrum antibiotic use, especially in ICU |
**Long-term and broad-spectrum antibiotic use, especially in ICU |
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**Immunosuppression |
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*[[Total parenteral nutrition]] |
**[[Total parenteral nutrition]] |
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*[[Acute kidney injury]], especially requiring [[dialysis]] |
**[[Acute kidney injury]], especially requiring [[dialysis]] |
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*Abdominal surgery |
**Abdominal surgery |
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*[[Gastrointestinal perforation]] |
**[[Gastrointestinal perforation]] |
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*Community-onset[[CiteRef::sofair2006ep]] |
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**Hospitalization within the past month |
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**HIV, malignancy, neutropenia, and diabetes similar to hospital-onset |
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**Less immunosuppressive therapy, recent surgery, or central venous catheters than hospital-onset, but still risk factors |
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==Clinical Manifestations== |
==Clinical Manifestations== |
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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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*Can be complicated by [[endophthalmitis]] |
*Can be complicated by [[endophthalmitis]] |
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=== Prognosis === |
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* Mortality of about 25%[[CiteRef::sofair2006ep]] |
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==Investigations== |
==Investigations== |
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Revision as of 11:59, 11 February 2021
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
- Hospital-onset
- Multiple or long-term IV lines, central lines, etc.
- Long-term and broad-spectrum antibiotic use, especially in ICU
- Immunosuppression
- Total parenteral nutrition
- Acute kidney injury, especially requiring dialysis
- Abdominal surgery
- Gastrointestinal perforation
- Community-onset1
- Hospitalization within the past month
- HIV, malignancy, neutropenia, and diabetes similar to hospital-onset
- Less immunosuppressive therapy, recent surgery, or central venous catheters than hospital-onset, but still risk factors
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
Prognosis
- Mortality of about 25%1
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
