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Candidaemia — SCE Infectious Diseases MCQ

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EasyFungal InfectionsCandidaemiaSCE Infectious Diseases

A 65-year-old man with myelodysplastic syndrome is on Azacitidine. He develops fever and blood cultures grow Candida krusei. He has no central venous catheter. What is the most important consideration regarding antifungal choice?

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Correct answer: E — Candida krusei is intrinsically resistant to Fluconazole; use an Echinocandin

Candida krusei has intrinsic (inherent) resistance to Fluconazole, unlike most other Candida species. First-line treatment is an echinocandin (Caspofungin, Micafungin, or Anidulafungin). Voriconazole is an alternative with good activity against C. krusei. C. glabrata also has reduced Fluconazole susceptibility (dose-dependent susceptibility or resistance). Speciation and antifungal susceptibility testing of all candidaemia isolates is essential for guiding therapy.

Reference: ESCMID 2024 – Candida guidelines; BSAC 2024 – Antifungal guidelines