Candida blood stream infection | Right Decisions

Right Decisions
Antimicrobial prescribing: NHS Lothian
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Blood stream infections and endocarditis
Candida blood stream infection

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Recommended total duration: 14 days from first negative blood culture after antifungals have been started, if no metastatic foci, and symptoms have resolved.

Risk factors include: GI surgery, diabetes mellitus, central vascular catheters, TPN, and urinary tract manipulation or surgery including stents.

For further information see SAPG guidance here.

Required investigations

Blood cultures: every 48h until documented clearance of Candida from blood
Dilated fundoscopic examination: Preferably by an ophthalmologist, within 7 days of diagnosis
Other investigations are dictated by likely source of Candida, and metastatic spread to other sites. Correlate with patient symptoms.
HIV screen

Antimicrobial recommendations

All cases will be managed in conjunction with an infection specialist. Advice can be found here.

IV to oral switch

Consider if the following criteria are met:

Minimum of 5 days IV therapy
Clinically stable
Repeat blood culture negative
Isolate is susceptible to oral agent