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Candidaemia — SCE Infectious Diseases MCQ

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ModerateFungal InfectionsCandidaemiaSCE Infectious Diseases

A 70-year-old man in the ICU has been on Meropenem for 10 days for ventilator-associated pneumonia. A new blood culture grows Candida albicans from two sets. He has a central venous catheter and is haemodynamically unstable. What is the most appropriate first-line treatment?

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Correct answer: C — Caspofungin IV

For candidaemia in a haemodynamically unstable critically ill patient, an echinocandin (Caspofungin, Micafungin, or Anidulafungin) is recommended first-line over Fluconazole due to its fungicidal activity against Candida and favourable pharmacokinetics in the critically ill. Both Caspofungin and Anidulafungin are acceptable; Caspofungin is the most commonly used in UK practice. The central venous catheter should be removed as source control. De-escalation to Fluconazole is appropriate once the species and sensitivity are confirmed (C. albicans is usually Fluconazole-sensitive) and the patient is clinically stable.

Reference: ESCMID 2024 – Candida guidelines; NICE 2023 – Invasive candidiasis