Fungemia: Difference between revisions
From IDWiki
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*Fever |
*Fever |
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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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| − | * |
+ | *Ocular infections in 16%, which as primarily [[chorioretinitis]], although [[endophthalmitis]] is possible |
| + | *[[Fungal endocarditis]] found in 8% |
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*In patients with community-onset candidemia and candiduria, many have fungal endocarditis |
*In patients with community-onset candidemia and candiduria, many have fungal endocarditis |
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*'''Never treat as a contaminant!''' |
*'''Never treat as a contaminant!''' |
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*'''Requires ophthalmology consult''' to rule out [[endophthalmitis]], ideally around 1 week after positive cultures |
*'''Requires ophthalmology consult''' to rule out [[endophthalmitis]], ideally around 1 week after positive cultures |
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| + | *Repeat 1 to 2 blood cultures every 24 to 48 hours until negative (1 culture q24h in ESCMID guidelines) |
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*Antifungal therapy |
*Antifungal therapy |
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**First-line (stable patients): [[fluconazole]] if no risk factors for a resistant species |
**First-line (stable patients): [[fluconazole]] if no risk factors for a resistant species |
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**Alternative (resistance or septic): [[micafungin]] or another [[echinocandin]] |
**Alternative (resistance or septic): [[micafungin]] or another [[echinocandin]] |
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**Alternative (last-line): [[amphotericin B]] |
**Alternative (last-line): [[amphotericin B]] |
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| + | *Duration |
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| + | **No organ involvement: 14 days from first negative |
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| + | **Ocular infection: until resolution of ocular findings, often 4 to 6 weeks |
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| + | **Endocarditis: at least 6 weeks; see [[fungal endocarditis]] |
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[[Category:Yeasts]] |
[[Category:Yeasts]] |
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Revision as of 11:24, 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
- Ocular infections in 16%, which as primarily chorioretinitis, although endophthalmitis is possible
- Fungal endocarditis found in 8%
- In patients with community-onset candidemia and candiduria, many have fungal endocarditis
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
- Repeat 1 to 2 blood cultures every 24 to 48 hours until negative (1 culture q24h in ESCMID guidelines)
- 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
- Duration
- No organ involvement: 14 days from first negative
- Ocular infection: until resolution of ocular findings, often 4 to 6 weeks
- Endocarditis: at least 6 weeks; see fungal endocarditis
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.
