The first step, even before starting treatment, is to identify who would be at risk for fungemia. Risk factors include neutropenia, being in the ICU, on TPN, on broad spectrum antibiotics, long-time central-line. Fungus in the sputum or urine may be a red herring, but fungus in the blood is NEVER normal.
Treating fungus depends on what kind it is. The major strains include:
- Candida albicans
- C. glabrata
- C. krusei (which is virtually fluconazole-resistant)
If a patient without risk factors at an institution where <15% are fluconazole resistant, it’s safe to treat with fluconazole. However, if not, then micafungin or even the terrible amphotericin B may be used.
P.S.- patients with fungemia should get a formal ophthalmology consult!