Critical Care Medicine-Infections and Immunologic Disease>>>>>Genitourinary Infection
Question 1#

A 67-year-old man has been intubated and sedated in the intensive care unit (ICU) for 6 days. He has a central venous catheter and an indwelling urinary catheter in place. He develops a fever to 38.4°C, and blood, urine, and sputum samples are sent for analysis. His urinalysis is notable for <10 white blood cells, negative for leukocyte esterase and nitrites. Urine culture grows >100,000 Candida glabrata after 2 days, susceptible to micafungin, caspofungin, and fluconazole.

What is the MOST appropriate way to manage the yeast growing in urine culture?

A. Give micafungin
B. Give fluconazole
C. No change in management
D. Remove the existing urinary catheter and replace with a new catheter

Correct Answer is D

Comment:

Correct Answer: D

Asymptomatic candiduria rarely requires treatment. Patients who should be treated for asymptomatic candiduria include neutropenic patients, very low birthweight infants, and patients with urinary tract (urologic) manipulation. Where possible, when candiduria is detected, it is strongly recommended that indwelling catheters be removed. If catheter removal is not possible, catheter exchange is recommended. Catheter exchange alone can lead to elimination of candiduria in 20% or more of patients with asymptomatic candiduria with no additional therapy. 

References:

1. Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1. Epub 2015 Dec 16.
2. Sobel JD, Kauffman CA, McKinsey D, et al. Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis. 2000;30(1):19.