American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the role of empiric antifungal therapy in managing candidemia?

1. To confirm the presence of the fungus

2. To immediately prevent metastasis

3. To target the most likely organism

4. To treat any existing antibiotic resistance

The correct answer is: To target the most likely organism

Empiric antifungal therapy plays a crucial role in the management of candidemia by targeting the most likely organism involved in the infection, which is typically Candida species. Candidemia can present with nonspecific symptoms, and given the potential for rapid deterioration and serious complications, timely administration of antifungal treatment is essential. By starting empiric therapy, clinicians aim to address the infection before specific culture results are available. This approach is vital because the identification of Candida species may take time, and patients with significant risk factors—such as those in intensive care units, those with recent antibiotic use, or those with central venous catheters—are at elevated risk for this type of fungal infection. The other options do not accurately capture the primary objective of initiating antifungal therapy in this context. For instance, empiric antifungal treatment does not serve to confirm the presence of the fungus; diagnosis is typically based on clinical suspicion and laboratory tests. It also does not immediately prevent metastasis, as systemic infections can still spread, and the treatment does not specifically tailor the therapy to any existing antibiotic resistance of the organism, since it's initiated prior to confirmation of organism susceptibility or resistance profiles. Thus, the focus of empiric therapy is on addressing the most likely pathogens