AM Report Pearls: IDSA Guidelines on Candiduria & Candidemia:

  • Check out IDSA guidelines here:
  • RCT by Sobel (prospective, multicenter, randomized, double-blinded, placebo-controlled) compared fluconazole (14 days) to placebo in treatment of candiduria in 316 asymptomatic patients
    • Note: they excluded patients with fevers
    • Treatment with fluconazole for candiduria resulted in short term but not long-term eradication and neither group had major complications such as pyelo/candidemia/death
    • 41% of patients with catheter-associated candiduria had resolution with catheter removal alone
  • Therefore, don’t treat asymptomatic candiduria, just remove predisposing factors/lines UNLESS:
    • Neutropenic patients
    • Infants with low birth weight
    • Patients undergoing urologic procedures (B-III evidence for recommending ppx fluc before)
  • Remember, for patients with candidemia, follow these principles:
    • Ophthalmologic exam to r/o endophthalmitis
    • Line removal
    • If persistently positive cultures or prosthetic valve, TTE to r/o fungal endocarditis
    • Duration of therapy is 2 weeks after documented clearance of Candida from bloodstream
  • For critically ill patients and empiric therapy of fungemia, best to start with echinocandin (caspofungin) b/c fluconazole does NOT cover C. glabrata as well
  • But remember fluconazole has better urinary penetration than Caspofungin

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