I have a patient who, after a bout in ICU and after 3 weeks of hospitalization, had Candida albicans growing in the urine (with no flank pain, or urinary urgency or discomfort), and also on her central venous catheter tip (only growing in 1 of 2 bottles). She has a Foley in and suffers from urinary incontinence. She also presents with symptoms of an URTI (query HAP query COPDE) However, blood cultures are negative in all bottles. Do you treat with fluconazole?
Risk factors for candiduria: elderly, female, indwelling urinary device, on broad-spectrum ABX, diabetes.
IDSA says: if blood cultures are positive, then definitely treat. However, asymptomatic candiduria is NOT treatable unless neutropenic, an infant, or will undergo urologic surgery. In other patients, treatment does NOT affect mortality. Definitely try and pull the Foley!
Data is lacking regarding negative blood cultures and positive cath tip cultures: data from this paper would seem to indicate that you would NOT treat just a positive cath tip culture. Given that this patient also does not present with symptoms of a UTI (she has urinary incontinence at baseline), it would seem that fluconazole treatment is NOT warranted.
UPDATE (Oct 21): so I found out that it is “common practice” to treat for 2 weeks after central catheter removal with an echinocandin (if you don’t know it’s an azole-susceptible Candida sp.) or fluconazole (if indeed Candida albicans). I guess it is playing it safe – catheter tip in the blood…treat AS IF it is a candidemia.
Osteomyelitis XR and CT “language”
– “Periosteal reaction” = usually means new bone is growing from destructed old bone due to either injury or infection
– “Osteolysis” = can be from inflammatory etiology or malignancy
– “Subperiosteal abscess” or “subcutaneous gas” = anaerobic involvement
In diabetic patients only, a probe to bone of an infected wound automatically means that the patient has osteomyelitis. No imaging is necessary.
Also learned that wound care nurses can be your best friend on an ID or AMS service…look for the “wet ones” to be infected, and “dry eschar” or the like to be infection mimics! Of course though, always correlate with clinical status and imaging.