Candidiasis

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Abdominal Candidiasis

Indications

There is conflicting and insufficient data to make hard recommendations. However, routine antifungal coverage is usually not indicated. Please consider sending fungal cultures from any intra-abdominal wound in the following categories (listed below). Positive culture results would warrant antifungal coverage. 

Empiric coverage should be considered in the following:

  • Toxic presentation in known foregut perforation (proximal to the ligament of Treitz)
  • Severe community-acquired or healthcare associated and if yeast is cultured from:
    • Intra-abdominal source expected to be sterile
    • Drains, if cultures drawn within 24 hours of placement
  • In patients not responding to antibiotics with the following:
    • Esophageal, gastroduodenal perforations
    • Anastomotic leaks
    • Necrotizing pancreatitis
    • Recurrent GI perforations
    • Other intra-abdominal events with isolation of candida spp

First line treatment

  • Micafungin 100 mg IV every 24 hours
  • De-escalate antifungal coverage once sensitivities are available. Please see additional information below. 

Duration

  • 4 days after source control*
    • With source control and good clinical response, 4 days of coverage after source control is reasonable. 

Notes

*Longer treatment regimens may be needed if:

  • Lack of source control
  • Immunosuppressed patients

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Disclaimer: The contents of this application are for the exclusive and specific use of University of Mississippi Medical Center faculty and trainees. Any other use is neither authorized nor sanctioned by UMMC. The information is for educational purposes only. The contents of this application are for the exclusive and specific use of UMMC faculty and trainees. Any other use is neither authorized nor sanctioned by UMMC. The information is for educational purposes only.