This podcast covers the diagnosis and treatment options for invasive candidiasis, including the importance of blood cultures and beta-D-glucan. It also discusses the necessity of echo cardiograms and dilated eye exams in Candidemia, as well as the therapy for antifungals in invasive candidiasis.
Identification of risk factors and hardware removal are crucial in managing invasive candidiasis.
Clinical manifestations of candidemia include pus-filled lesions and rashes, and diagnosis is made through blood cultures.
Deep dives
Diagnosing and Treating Invasive Candidiasis
Invasive candidiasis, specifically candidemia, is a serious infection that requires prompt treatment. It is important to differentiate between colonization and true invasive infection. Patients in the ICU who are on broad-spectrum antibiotics for extended periods are at risk of Candida colonization. Identification of risk factors such as immunosuppression, prolonged ICU stay, and violation of anatomic barriers can help suspect invasive candidiasis. Hardware removal is crucial in achieving source control. Initial therapy involves using an echinocandin, such as Caspofungin, Micafungin, or Anidulafungin. De-escalation to fluconazole may be considered if the species is susceptible. Treatment duration depends on the type of infection, with uncomplicated infections requiring 14 days of therapy, while more complex cases may require longer treatment.
Clinical Manifestations and Diagnosis
Clinical manifestations of candidemia include pus-filled lesions and rashes, typically observed in patients with severe immunosuppression. Eye involvement, although rare, may present with redness or prevalence layering in the anterior chamber. Diagnosis of Candida in the bloodstream is made through blood cultures. Beta-D-glucan testing can be helpful, although it may have false positives in cases of heavy colonization. While there is a guideline recommendation for dilated eye exams in all candidemia patients, its utility is debated and may not necessarily impact management decisions. Echocardiograms can be considered, and source control is crucial for managing abdominal infections.
Treating Specific Organ Infections
Candida can infect various organs, such as the lungs and urinary tract. Pulmonary infections are rare in non-immunosuppressed patients, while urinary or sputum colonization is common and often does not require treatment. Treatment for tertiary peritonitis or abdominal infections involves source control and selecting appropriate antifungal therapy, which may include fluconazole or alternative drugs depending on susceptibility. Duration of therapy varies based on the resolution of infection, typically lasting 14 days for uncomplicated cases. Invasive candidiasis should be treated promptly, but differentiation between colonization and true infection is important to avoid unnecessary treatment.
In this episode, we cover that variable response to when the lab calls with a culture positive for candida. Lines, blood, Urine. Labs, Anti-fungals, imaging... we got it all.
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