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Candidaemia Step-Down Oral — SCE Infectious Diseases MCQ

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HardHealthcare-Associated InfectionsCandidaemia Step-Down OralSCE Infectious Diseases

Candida tropicalis catheter-related candidaemia clears after catheter removal and an echinocandin. The isolate is fluconazole susceptible, the patient is stable and repeat cultures remain negative. What step-down plan is appropriate?

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Correct answer: A — Change to oral fluconazole and complete at least 14 days from documented bloodstream clearance

The best answer is “Change to oral fluconazole and complete at least 14 days from documented bloodstream clearance”. Stable patients can step down after clearance and susceptibility confirmation; uncomplicated candidaemia duration is counted from the first negative culture and symptom resolution. Deep Candida infection requires species identification, susceptibility-guided systemic therapy and source control, with prosthetic-joint infection usually needing implant removal.

Reference: ESCMID Candida guideline: https://pubmed.ncbi.nlm.nih.gov/23137135/