Invasive candidiasis

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

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

• vascular catheter removal
• 1st line: IV Echinocandins (Caspofungin, Anidulafungin, Micafungin)
• 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, Voriconazole
• Alternative: Amphotericin B is acceptable but carries a higher toxicity and side-effect profile

Disposition

• Admission

See Also

• Candidiasis