Fungal Sepsis

A 67-year-old man is on day 9 in the intensive care unit of a community hospital after emergency bowel resection for a perforation. He has had a central venous catheter for 8 days, receives total parenteral nutrition, and has been on broad-spectrum antibacterials for 7 days. Overnight his temperature rises to 38.9 °C, his heart rate to 118/min and his blood pressure falls to 92/54 mmHg, even though the antibacterials continue. The laboratory phones to say that yeast is growing in his blood cultures. As his RN, you must decide what to report, how fast, and what to prepare. Clinical priority: persistent fever and hypotension in a critically ill patient with a central line, parenteral nutrition and recent abdominal surgery are reported at once as possible fungal sepsis; the team starts the ordered antifungal without waiting for further results. By the end of this lesson you will be able to: - recognize the risk factors and the early, concerning and emergency signs of candidemia and septic shock; - explain why catheters, biofilm and the gut matter, and why a negative...