{"id":4912,"date":"2014-01-21T18:18:05","date_gmt":"2014-01-21T23:18:05","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=4912"},"modified":"2015-06-04T14:32:37","modified_gmt":"2015-06-04T18:32:37","slug":"unanswerable-questions-in-infectious-diseases-the-positive-culture-for-candida-in-an-icu-patient","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/unanswerable-questions-in-infectious-diseases-the-positive-culture-for-candida-in-an-icu-patient\/2014\/01\/21\/","title":{"rendered":"Unanswerable Questions in Infectious Diseases: The Positive Cultures for Candida in an ICU Patient"},"content":{"rendered":"

\"question\"<\/a>OK, gang. You did such a bang-up job on Question #1<\/a> that I can’t resist getting another consult.<\/p>\n

Here’s the case: \u00a0Patient in intensive care, has been there for some time — at least a week, probably weeks. Perhaps he\/she had surgery (especially abdominal surgery) that didn’t go well, or has severe cardiovascular disease, or multiple trauma from an MVA, or suffered a large intracerebral hemorrhage or stroke. There have been several antibiotic “courses” directed at fevers of too many origins.<\/a><\/p>\n

Each day you see the patient, and each day there’s a fever — generally 100.5 or a bit higher. Normotensive. Nothing obvious on exam. Labs show a WBC of 11-15 — in other words, not normal but not horribly abnormal either. LFTs are fine.<\/p>\n

All bacterial cultures are unrevealing. Several sputum cultures, however, are positive for Candida; a urine culture (from a foley catheter) is positive also. If the patient has an abdominal drain, it has a few yeast in there too. Imaging is non-specifically abnormal — some pleural effusions, but no obvious pneumonia; CT shows no abscess.<\/p>\n

So here’s the question:<\/p>\n

Should patients in the ICU be given systemic treatment for Candida spp.<\/em> if they have positive cultures from multiple sites other than blood?<\/strong><\/p>\n

If you want to research the question, here are a couple of randomized trials here<\/a>\u00a0and here<\/a>, concluding yay and nay, respectively.<\/p>\n

Or just go ahead and vote, and have at it in the comments section.
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Patient in ICU has fever and candida growing from multiple sites. Start treatment?<\/strong><\/p>