The source of the pathogen in surgical patients is usually the digestive tract
Multiple scoring systems exist to predict risks
Becomes invasive only when it changes from yeast to hyphal form!
Disseminated candidal disease can cause septic shock
Very high false negative rate for cultures
Indistinguishable from bacterial sepsis clinically
Can look for purpura fulminans or unexplained myalgias
Diagnosis essentially requires strong clinical suspicion for susceptible patients
Symptomatic candiduria should be treated. Asymptomatic should only be treated after instrumentation or renal transplant, or if the patient is neutropaenic. Changing IDC is required.
Need two positive samples to consider a patient infected as opposed to contaminant. Whether that is blood culture, histological evidence, or line culture.
If accompanied by temp >38.5 or <36, unexplained prolonged hypotension (SBP<80 for 2 hours, unresponsive to fluid), and absence of response to adequate antibiotics, then considered severe candidiasis.
Some authorities believe candida pneumonia does not exist in immunocompetent hosts
