American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the initial management for a patient with candidemia associated with an intravenous catheter?

1. Empiric antiviral therapy

2. Remove the catheter and initiate antifungal therapy

3. Start broad-spectrum antibiotics

4. Delay treatment and monitor closely

The correct answer is: Remove the catheter and initiate antifungal therapy

For a patient with candidemia associated with an intravenous catheter, the initial management involves both removing the catheter and initiating antifungal therapy. This approach is critical because the catheter often serves as a source of the infection, and addressing it is essential for effective treatment. Removing the catheter helps to eliminate the primary source of the Candida infection, which is key to preventing further dissemination of the organism into the bloodstream. Additionally, starting antifungal therapy promptly is important to manage the infection and mitigate complications, especially given the potential morbidity associated with invasive candidiasis. Immediate treatment reduces the risk of seeding other organs and helps to ensure a favorable clinical outcome. The other options would not provide an adequate or timely response to the infection. For instance, starting broad-spectrum antibiotics would not be appropriate because antibiotics do not target fungal pathogens like Candida; in fact, they can alter the microbiome further, potentially allowing for fungal overgrowth. Delaying treatment and monitoring closely could risk worsening the patient's condition or allowing the infection to progress. Similarly, initiating an antiviral therapy would not address a fungal infection and would therefore be ineffective. Thus, the combination of catheter removal and antifungal therapy is the most effective initial management strategy for candidemia in this context.