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Invasive Candidiasis (diagnostic criteria and testing (traditional…
Invasive Candidiasis
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treatment options
echinocandins
caspofungin (Cancidas), anidulafungin (Eraxis), micafungin (Mycamine)
MOA: inhibits synthesis of β(1,3)-D-glucan, an essential component of the cell wall of susceptible fungi
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azole derivatives
fluconazole (Diflucan), itraconazole (Sporanox), voriconazole (Vfend), ketoconazole
fluconazole absorption is not affected by food, gastric pH, or disease state
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MOA: interferes with fungal CYP450 activity (lanosterol 14-α-demethylase), decreasing ergosterol synthesis and inhibiting cell membrane formation
CIs: 1st trimester of pregnancy, coadministration with CYP3A4 substrates (may lead to QTc prolongation)
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AEs: GI upset, DILI, concentration-associated vision changes/hallucinations (voriconazole), QTc prolongation in high doses, reversible alopecia (fluconazole)
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flucytosine (Ancobon)
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MOA: penetrates fungal cells and is converted to fluorouracil which competes with uracil interfering with fungal RNA and protein synthesis
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monitoring and follow-up
immunocompromised pts must be monitored carefully with serial blood cultures and careful physical examinations, particularly of the retina
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special populations
cancer pts
central venous catheters (CVCs) should be removed as early as possible when the source is presumed to be the CVC unless pt has cancer
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epidemiology
candidemia has increased substantially in the past decades and is the 4th most common bloodstream infection in US hospitals
associated with high mortality, increased length of hospital stay, and significant economic burden
most Candida bloodstream infections now occur in nonneutropenic pts who have been hospitalized in ICUs