Fungemia

Candidemia

Definition

• 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