## Sites of Invasive Candidiasis **Key Point:** Bloodstream infection (candidemia) is the most common manifestation of invasive candidiasis in hospitalized and critically ill patients, accounting for 40–50% of invasive candida infections. ### Frequency of Invasive Candidiasis by Site | Site | Frequency | Risk Factors | |------|-----------|---------------| | Bloodstream (candidemia) | 40–50% | Central lines, ICU stay, broad-spectrum antibiotics | | Urinary tract | 30–40% | Indwelling catheters, urinary stasis | | Peritoneal/intra-abdominal | 10–15% | Abdominal surgery, perforation | | Respiratory tract | 5–10% | Mechanical ventilation, aspiration | | CNS (meningitis) | <5% | Immunosuppression, disseminated disease | **High-Yield:** Candidemia is a marker of systemic infection and carries high mortality (30–50%) if not treated promptly. It often arises from translocation through damaged mucosa or from contaminated central venous catheters. ### Clinical Pearl In critically ill patients with risk factors (central lines, prolonged ICU stay, recent broad-spectrum antibiotics, renal failure), candidemia should be suspected with fever unresponsive to antibiotics. Blood cultures remain the gold standard for diagnosis. **Warning:** Do not confuse candiduria (fungal colonization of urine) with invasive urinary tract candidiasis. Candiduria alone does NOT require antifungal therapy unless the patient is symptomatic or has upper urinary tract involvement. ### Mnemonic **CRIB** — Candidemia Risk in ICU Patients: - **C** — Central lines (most important risk factor) - **R** — Recent antibiotics (disrupted normal flora) - **I** — ICU stay (severity of illness) - **B** — Broad-spectrum coverage (selects for Candida) [cite:Harrison 21e Ch 197]
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