Invasive candidiasis: Difference between revisions
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==Background== | ==Background== | ||
* Candida is an important nosocomial infection that requires evaluation to identify a source: central line cathether, intravenous catheter, indwelling foley catheter, recent abdominal surgery with anastamotic leak | *Candida is an important nosocomial infection that requires evaluation to identify a source: central line cathether, intravenous catheter, indwelling foley catheter, recent abdominal surgery with anastamotic leak | ||
* Associated with candidemia with further hematogenous spread to visceral organs (heart, kidney, liver, spleen, eye, brain, skin, joints etc) | *Associated with candidemia with further hematogenous spread to visceral organs (heart, kidney, liver, spleen, eye, brain, skin, joints etc) | ||
==Clinical Features== | ==Clinical Features== | ||
* presence of biofilms on catheter | *presence of biofilms on catheter | ||
* fever and chills unresponsive to antibiotics | *fever and chills unresponsive to antibiotics | ||
* chorioretinitis | *chorioretinitis | ||
* muscle abscesses | *muscle abscesses | ||
* skin lesions with satellite pustules | *skin lesions with satellite pustules | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
==Evaluation== | ==Evaluation== | ||
* positive blood culture | *positive blood culture | ||
* positive culture of blood, tissue, urine from normally sterile sites | *positive culture of blood, tissue, urine from normally sterile sites | ||
* biopsy of skin lesions for gram staining | *biopsy of skin lesions for gram staining | ||
* beta-D-glutan assay can be a diagnostic adjunct to blood cultures and identify systemic fungal infections weeks before positive blood cultures | *beta-D-glutan assay can be a diagnostic adjunct to blood cultures and identify systemic fungal infections weeks before positive blood cultures | ||
==Management<ref name=invasive>Kullberg BJ, Arendrup MC Maiken, Invasive Candidiasis. N Engl J Med 2015; 373:1445-1456.</ref>== | ==Management<ref name=invasive>Kullberg BJ, Arendrup MC Maiken, Invasive Candidiasis. N Engl J Med 2015; 373:1445-1456.</ref>== | ||
* | *Vascular catheter removal | ||
* 1st line: IV Echinocandins | *1st line: IV Echinocandins | ||
* Step down therapy: as early as 5 days, can step down to oral if blood stream is clear and patient can tolerate oral regime | **[[Caspofungin]] 70mg IV day 1, 50mg IV Qdaily x 14 days following the last positive blood culture | ||
* 2nd line: [[Fluconazole]], [[Voriconazole]] | **[[Anidulafungin]] 200mg IV day 1, 100mg IV Qdaily x 14 days following the last positive blood culture | ||
* Alternative: [[Amphotericin B]] is acceptable but carries a higher toxicity and side-effect profile | **[[Micafungin]] 100mg IV Qdaily x 15 days | ||
**Step down therapy: as early as 5 days, can step down to oral if blood stream is clear and patient can tolerate oral regime | |||
*2nd line: | |||
**[[Fluconazole]] 800mg IV loading dose, 400mg (6mg/kg) IV Qdaily for 14 days following first negative blood culture | |||
**[[Voriconazole]] 400mg (6mg/kg) IV Q12 hours x 2 doses (loading dose), 200mg (3mg/kg) IV Q12 x 14 days following first negative blood culture (maintenance dose) | |||
*Alternative: | |||
**[[Amphotericin B]] is acceptable but carries a higher toxicity and side-effect profile | |||
**1mg/kg/day IV x 14 days following first negative blood culture | |||
==Disposition== | ==Disposition== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | |||
Latest revision as of 15:37, 27 October 2016
Background
- Candida is an important nosocomial infection that requires evaluation to identify a source: central line cathether, intravenous catheter, indwelling foley catheter, recent abdominal surgery with anastamotic leak
- Associated with candidemia with further hematogenous spread to visceral organs (heart, kidney, liver, spleen, eye, brain, skin, joints etc)
Clinical Features
- presence of biofilms on catheter
- fever and chills unresponsive to antibiotics
- chorioretinitis
- muscle abscesses
- skin lesions with satellite pustules
Differential Diagnosis
Evaluation
- positive blood culture
- positive culture of blood, tissue, urine from normally sterile sites
- biopsy of skin lesions for gram staining
- beta-D-glutan assay can be a diagnostic adjunct to blood cultures and identify systemic fungal infections weeks before positive blood cultures
Management[1]
- Vascular catheter removal
- 1st line: IV Echinocandins
- Caspofungin 70mg IV day 1, 50mg IV Qdaily x 14 days following the last positive blood culture
- Anidulafungin 200mg IV day 1, 100mg IV Qdaily x 14 days following the last positive blood culture
- Micafungin 100mg IV Qdaily x 15 days
- Step down therapy: as early as 5 days, can step down to oral if blood stream is clear and patient can tolerate oral regime
- 2nd line:
- Fluconazole 800mg IV loading dose, 400mg (6mg/kg) IV Qdaily for 14 days following first negative blood culture
- Voriconazole 400mg (6mg/kg) IV Q12 hours x 2 doses (loading dose), 200mg (3mg/kg) IV Q12 x 14 days following first negative blood culture (maintenance dose)
- Alternative:
- Amphotericin B is acceptable but carries a higher toxicity and side-effect profile
- 1mg/kg/day IV x 14 days following first negative blood culture
Disposition
- Admission
See Also
External Links
References
- ↑ Kullberg BJ, Arendrup MC Maiken, Invasive Candidiasis. N Engl J Med 2015; 373:1445-1456.