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
