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, Faites-vous un relais antibiotique par voie orale? Non applicable, j'ai déjà commencé par une antibiothérapie par voie orale Oui, après 48-72 heures d'antibiothérapie intraveineuse Oui, après 7-10 jours d'antibiothérapie intraveineuse Oui

, si les autres investigations ont montrées que la bactériémie pouvait être considérée comme non compliquée? Nous vous interrogeons ici sur votre pratique habituelle concernant la gestion d'une candidémie chez un adulte immunocompétent, sans signe de sepsis, avec une fonction rénale normale, sans comorbidité ni allergie, Combien de temps traitez-vous cette bactériémie (à partir du début de traitement par l'antibiotique adapté)

, Il n'y a pas de facteur de risque d'endocardite, pas de matériel implantable en place, ni foyer infectieux primaire ou secondaire cliniquement évident, et la candidémie est nosocomiale, en rapport avec un cathéter; le cathéter a été rapidement retiré. Nous imaginons un "scénario idéal

, Quelles investigations réalisez-vous systématiquement à la recherche de complication ou d'une porte d'entrée?

, antifongique(s) A ± B (en dénomination internationale) et dose totale journalière (en milligrammes par jour)

, Quel(s) antifongique(s) prescrivez-vous habituellement chez un patient présentant une candidémie à C. albicans? Indiquez la première ligne de traitement ciblé que vous allez prescrire, en monothérapie ou en association Quelle dose totale journalière (en milligrammes par jour) prescrivez-vous chez ce patient adulte de 85 kg avec une fonction rénale normale? Quelle voie d'administration utilisez-vous quand vous débutez le traitement? Candida albicans

, Réalisez-vous des hémocultures de contrôle 48-72 heures après le début du traitement anti-infectieux approprié? Oui Non, L'évolution clinique est rapidement favorable

, Est-ce que vous réalisez un relais par un traitement antifongique oral? Non applicable, j'ai déjà commencé par un traitement antifongique par voie orale Oui, après 48-72 heures de traitement antifongique intraveineux Oui, après 7-10 jours de traitement antifongique intraveineux Oui

, Combien de temps traitez-vous cette candidémie (à partir de la première hémoculture négative), si les investigations complémentaires ont montré que la candidémie est non compliquée? Merci pour votre participation

C. Wintenberger, B. Guery, E. Bonnet, B. Castan, R. Cohen et al., Proposal for shorter antibiotic therapies, Med Mal Infect, vol.47, pp.92-141, 2017.

, Avis d'expert

. Méropénème,

C. Pappas, P. G. Kauffman, C. A. Andes, and D. R. , All infection specialists, senior or trainees, giving at least weekly advice on positive blood cultures could participate. Their practices were evaluated using six clinical vignettes presenting uncomplicated BSI cases. RESULTS: Six hundred and sixteen professionals from 56 countries participated (333/616, 54% infectious diseases specialists, 188/616, 30% clinical microbiologists), 76% (468/616) being members of an antimicrobial stewardship team. Large variations in practice were noted, Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America, vol.62, pp.1-50, 2016.