Incidental culture positives, colonizers Flashcards
candida in sputum sample
generally seen in critically ill pts on mechanical ventilation and it’s not an infection
incidence of true candida pneumonia and invasive dx
rare
what causes TRUE candida pneumonia
not due to aspiration or oropharyngeal secretions but rather due to hematologenous spread from disseminated candidasis (osteomyelitis, septic arthritis, endocarditis)
what to do with candida in sputum culture or BAL?
don’t repeat cultures or treat with antifungals for immunocompetent pts.
When do we treat candida in the sputum or BAL for mechanically ventilated pts?
treat with antifungal treatment for immunocompromised
when do we treat Candida in immunocompetent pts with antifungals
Only treat if they have a primary candida infection at another site and develop new pulmonary lesions suspicious for hematogenous spread of candida
what to treat with invasive candidiasis?
fluconazole for candidemia
micafungin (echinocandins) is preferred for severe illness or recent azole exposure.
what to do for asymptomatic candiduria with someone who has a chronic urinary catheter and has candida in urine culture?
needs only catheter removal or exchange. they have chronic colonization and so need to replace.
DO NOT give antifungal tx for asymptomatic pts.
what to do for asymptomatic candiduria with someone who has a chronic urinary catheter and has persistent candiduria despite catheter exchange or removal?
need to get imaging to evaluate for a perinephric abscess, fungal ball, or hydronephrosis.
what causes asymptomatic candiduria in pt who have chronic urinary catheters?
chronic colonization
persistent candiduria (in DM2) need to get what?
CT or renal u/s after catheter exchange or removal to rule out hydronephrosis, perinephric abscess and possible fungus ball (rare complication that needs surgical intervention)
who is at high risk for disseminated candidasis and needs treatment for antifungals?
those who are adults with neutropenia
those who are undergoing urological procedures and have candiduria
what to do for symptomatic candiduria?
flank pain, abdominal pain,
CVA tenderness
treat with antifungal therapy based on Candida species identified, and based on extent of infection and based on suspected etiology (either uTI or blood source)
that to do for: asymptomatic candiduria with anticipated urological procedure?
consider systemic antifungals prior to and following procedure
what to do for someone with asymptomatic candiduria and neutropenic host?
treat as disseminated candidasis
