Self-Assessment in Adult Multiprofessional Critical Care by Pino MD Richard M. & Zanotti-Cavazzoni MD FCCM Sergio L

Author:Pino MD, Richard M. & Zanotti-Cavazzoni MD FCCM, Sergio L. [Pino MD, Richard M.]
Language: eng
Format: epub
Publisher: Society of Critical Care Medicine
Published: 2011-06-30T16:00:00+00:00

RATIONALE (11) Answer: C

Abdominal surgery is a risk factor for the development of candidiasis/candidemia. Since the patient has not responded to appropriately broad antibacterial therapy, it is reasonable to suspect that he may have a Candida infection; it may be localized to the peritoneum or systemic in the bloodstream. Candida are commensals of the human gastrointestinal tract. Thus, they are frequently encountered in gastrointestinal-associated infections. In 2009, the Infectious Diseases Society of America released updated treatment guidelines for candidiasis. These guidelines recommend that an antifungal from the echinocandin class be used to treat candidiasis in moderately to severely ill patients. The guidelines do not distinguish between the 3 FDA-approved echinocandins. Since caspofungin is the only listed echinocandin, it is the most correct choice (option C). The echinocandins are fungicidal for Candida species. While fluconazole (option D) has been used empirically for years to treat candidiasis, it is fungistatic. Therefore, the recommendation is to use an echinocandin in critically ill patients. Amphotericin B products are also fungicidal for Candida species. However, all amphotericin B– containing medications have increased toxicity over the echinocandins. Because of this excess toxicity, amphotericin B should be used as a second-line agent in patients who have had an adverse or allergic response to echinocandins. Therefore, options A and B are incorrect.

REFERENCE (11)

Pappas et al. Clinical Practice Guidelines for the Management of Candidiasis: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009;48:503–35.

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