Question #11 explained:
AJ is a 32 year-old male who underwent a deceased donor kidney transplant (DDKT) two months ago. He has not done well after the transplant and is currently being managed in a surgical intensive care unit. At this time he has been febrile for 72 hours and the infectious disease consult service is called in to assist. The patient has been on meropenem to cover for a Gram negative rod isolated from a sputum culture plus he is on linezolid for broad-spectrum coverage of Gram positive bacteria. He now has a urine culture positive for yeast. During rounds the attending physician notes she usually does not treat yeast in the urine, because it typically represents colonization/ contamination rather than infection, however in this case the patient is immunocompromised and she feels it is reasonable to give an antifungal drug. Which of the following would be out of the question for covering for a potential fungal UTI?
A. Fluconazole (Diflucan)
-
-
- While drug-drug interactions with immunosuppressants and Azole antifungals may be problematic, this can be managed and these drugs can be used to treat fungal UTI.
-
B. Voriconazole (VFEND)
-
-
- While drug-drug interactions with immunosuppressants and Azole antifungals may be problematic, this can be managed and these drugs can be used to treat fungal UTI. Depending on the type of yeast, voriconazole may be considered, but would probably only be employed if the clinician also wanted coverage for Aspergillus (a mold).
-
C. Micafungin (Mycamine) CORRECT
-
-
- Echinocandins like micafungin, anidulafungin, and caspofungin do not concentrate in the urine and are therefore not good options for fungal UTI.
-
D. Amphotericin B lipid formulation (Abelcet)
-
-
- While amphotericin B products can be nephrotoxic and this may be a major concern in a kidney transplant patient, it can be an option for fungal UTI.
-