Question

1. One of your hospitalized patients with a subclavian central venous catheter has been on tigecyline, a very broad spectrum antibiotic (with activity against gram-positive, gram-negatives and anaerobes), but develops a new fever after 3 days of therapy. His blood culture is negative for bacterial growth, but positive for Candida albicans. What treatment is warranted?
   1.   ?    Ciprofloxacin
   2.   ?    Cefepime
   3.   ?    Cefepime + Metronidazole
   4.   ?    Fluconazole
   5.   ?    Metronidazole

Answer 1

Candida albicans is part of our natural microflora — or the microorganisms that commonly live in or on our bodies. It can be found in the GI tract, the mouth, and the vagina.

Most of the time it causes no issues, but it’s possible for overgrowths and infections to happen.

Candida albicans is the most prevalent cause of fungal infections in people. Its species name, albicans, comes from the Latin word for “white.” The yeast appears white when cultured on a plate. And in the case of certain infections, like thrush, it can create white patches.

Candidemia is a blood infection with Candida species.

Risk factors for candidemia include:

• immunosuppression
• use of broad-spectrum antibiotics
• major surgery
• placement of a medical device such as a feeding tube or catheter

Symptoms

Symptoms can resemble those of bacterial sepsis and can include:

• fever
• kidney failure
• shock

Diagnosis and treatment

Candidemia can be diagnosed when the yeast is isolated from a blood sample.

Treatment may depend on the species of Candida causing the infection, but can include IV doses of fluconazole, caspofungin, micafungin, or amphotericin B. Catheters should also be removed.

Cefepime + Metronidazole and Metronidazole are an antibiotic medicine.

But fluconazole is an antifungal medicine.

Thus the ans is fluconazole,