The Significance of Candidemia

Abstract

All patients with more than 1 blood culture positive for Candida for 5 years were studied for a pattern to aid in the selection of those cases requiring systemic chromatography. There were 12 cases with serious underlying disease, multiple antibiotics and plastic intravenous catheters. Two patients had candidemia preterminally and no evidence of tissue infection at necropsy. Four patients had transient and even prolonged candidemia in the course of a complex clinical setting and survived without therapy. Two patients were treated because of potential foci of Candida sepsis at the time of candidemia. One of these died without evidence of disseminated disease. Four patients had disseminated candidiasis at necropsy. This group was distinguished by a deteriorating clinical course at the time of the candidemia, the sudden appearance of masses of yeast in the urine in 3 of the 4, high dose corticosteroid therapy in 2 and background lymphoproliferative disease in 2. Immediate amphotericin B therapy should be institututed in those patients with candidemia and this clinical profile and contributing factors such as antibiotics, intravenous catheters and corticosteroids discontinued. Reculturing the blood is more appropriate in others whose candidemia may be transient.