Candidemia

Today we discussed candidemia. The 2009 IDSA guidelines are available here.

In general:

• If the patient is critically ill, has recently been exposed to azoles, or the local prevalence of azole resistant candida is high initial therapy should be an echinocandin. Otherwise an azole like fluconazole would be appropriate.
  
• Line foci *must* be removed
• You should look for metastatic spread including the eyes or heart valves. Other investigations to look for osteomyelitis or septic thrombophlebitis should be based on history and clinical suspicion.
• Treatment duration varies depending on complication. In general, if there is no evidence of metastatic spread of infection treatment duration is 2 weeks after the last negative culture. There should be some clinical and microbiological follow-up to document relapse.