candidemia
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Introduction
Disseminated (blood-borne) candidiasis.
Etiology
(risk factors):
- immunocompromised hosts
- indwelling catheters
- antibiotics
- prolonged use of antibiotics (> 28 days)
- multiple antibiotics (3-5 days)
- Candida at other sites
- ventilator for more than 7 days
- renal failure (hemodialysis)
Epidemiology
- incidence 0.7/1000 patient days
- Candida albicans 54%, Candida glabrata 17%
Clinical manifestations
- fever
- malaise
- pharyngitis
- muscle tenderness
- erythematous papular rash
- oral thrush
- retinal infection
Laboratory
- abscesses contain mycelia resembling yeast
- serology
- blood culture is the gold standard for diagnosis
- repeat blood cultures until negative[3]
- T2 MRI assay of whole blood if culture-negative[3]
Diagnostic procedures
Complications
- 30-40% mortality[3]
Management
- all Candida isolates from blood should be considered pathogenic
- failure of treatment may be a result of colonization of intravascular catheters
- remove intravascular catheters & indwelling ports[3][8]
- if associated abscess, incision & drainage of abscess
- removal of central venous catheter may not be of benefit (old)[5]
- antifungal agents
- echinocandin for critically ill patients
- liposomal amphotericin B
- as effective as echinocandins but is nephrotoxic[3]
- fluconazole
- formerly drug of choice, but resistance a problem[3]
- only appropriate if fluconazole susceptibility documented
- overall resistance 5.3%[4]
- Candida albicans 0%
- Candida glabrata 15%
- Candida krusei 71%
- may be useful for Candida prophylaxis in neutropenic cancer patients but limited effectiveness against other fungal infections[3]
- formerly drug of choice, but resistance a problem[3]
- voriconazole
- continue antifungal treatment for 2 weeks after blood cultures become negative[3]
- ophthalmology referral (risk of retinal infection)
- CNS or eye infection: treatmemt with azole or liposomal amphotericin B[3]
- mortality 62% of ICU patients with candidemia[4]
More general terms
Additional terms
References
- ↑ Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 871
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 Medical Knowledge Self Assessment Program (MKSAP) 11,16,17,18. American College of Physicians, Philadelphia 1998,2012,2015,2018.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 4.0 4.1 4.2 4.3 Bougnoux M-E et al, Candidemia and candiduria in critically ill patients admittted to intensive care units in France: Incidence, molecular diversity, management and outcome. Intensive care Med 2008, 34:292 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17909746
- ↑ 5.0 5.1 Nucci M et al. Early removal of central venous catheter in patients with candidemia does not improve outcome: Analysis of 842 patients from 2 randomized clinical trials. Clin Infect Dis 2010 Aug 1; 51:295. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20578829
Brass EP and Edwards JE Jr. Should the guidelines for management of central venous catheters in patients with candidemia be changed now? Clin Infect Dis 2010 Aug 1; 51:304. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20578828 - ↑ 6.0 6.1 Pappas PG, Kauffman CA, Andes D, Benjamin DK et al Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Mar 1;48(5):503-35. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19191635
- ↑ Kullberg BJ, Arendrup MC Invasive Candidiasis N Engl J Med 2015; 373:1445-1456. October 8, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26444731 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1315399
- ↑ 8.0 8.1 NEJM Knowledge+