How do you typically manage a patient with a single positive blood culture from two sets growing Candida species in a stable patient without prosthetic devices or material?

Candidemia is defined as the presence of Candida species in the blood, and even a single positive blood culture specimen is considered significant and warrants treatment as candidemia. Initial management should include:

1. Initiating antifungal therapy with an echinochandin (micafungin, capsofungin, or anidulafungin) while awaiting blood culture susceptibility data on the isolate.
2. Repeat blood cultures to ensure clearance of candidemia. If an isolate is azole susceptible, can transition to an azol...

Looking for the source would be key to guiding therapy and the need for further workup. Was it an indwelling Foley or a central line? If removed and exchanged, and blood cultures are clear and no concerns for endocarditis, 2 weeks of antifungal therapy would be enough. I would start with echinocandins IV, then switch to azole therapy depending on the final ID and susceptibility of the isolate.

Look for any source, and repeat the blood cultures.

Overwhelmingly depends on clinical circumstances. C albicans is an uncommon but not unheard of contaminant. If otherwise asymptomatic without prosthetic material or long-term IV catheter, I would repeat blood cultures x2 every 3-4 days x 7-10 days and withhold antifungal therapy pending blood culture results.

If hospital onset and prompt therapy are initiated and no visual complaints, I do not think a bedside ophtho exam is required, and on a practical level, it can be difficult to obtain. Recommend outpatient ophtho in the office instead. Curious how much fungal endophthalmitis people have seen. I have never seen it.