CURRENT Essentials of Critical Care.pdf

140 Current Essentials of Critical Care■■■Hematogenously Disseminated CandidiasisEssentials of Diagnosis• Persistent fever despite broad-spectrum antibiotics; may becomplicated by candida endocarditis, osteomyelitis, arthritis, hepatospleniccandidiasis, endophthalmitis, CNS abscesses• Risk factors: number of antimicrobial agents given, duration ofantimicrobial therapy, total parenteral nutrition, neutropenia,hemodialysis, colonization with candida, extensive surgeries,burns• Candida fourth leading organism isolated from blood culturesin hospitalized patients; however, sensitivity of blood culturesfor detecting candidemia 50%• C albicans most common species isolated (59%); but increasingisolation of nonalbicans species, especially C glabrataDifferential Diagnosis• Noninfectious source of persistent fever (DVT, drug fever, embolicevents)• Other infectious causes of fever (bacteria, mycobacteria, viruses,other fungi)Treatment• Empiric antifungal therapy in patients with persistent fever andsignificant risk factors• Antifungal agent selected depends on knowledge of Candidaspp and patient’s status• Amphotericin B standard treatment; consider fluconazole innon-neutropenic patients with susceptible Candida spp• Role of newer antifungal agents in candida bloodstream infectionunder investigation• Removal of indwelling catheters strongly advised■ PearlPresence of endophthalmitis must be excluded in patients with candidemia;if found, prolonged systemic therapy, and, in advanced cases,vitrectomy required.ReferenceSpellberg B: The pathophysiology and treatment of candida sepsis. Curr InfectDis Rep 2002;5:387. [PMID: 12228025]