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id.candidemia.core.v1

Candidemia / invasive candidiasis

infectious_diseaseacuteadultacuteinpatient
Start encounter →Print handoutPRODUCTION

Manifest is a Batch-23 scaffold (defineBatch23ScaffoldManifest) — atoms / package / phenotypes not yet authored as a Tier-3 package. Deepened 2026-05-12 (B.5 ID/CC lane): the regimen axis IS authored (caspofungin/micafungin/anidulafungin/fluconazole/liposomal-AmB/voriconazole with RxCUIs), the setting playbooks IS authored (inpatient + ICU), and the terminology arrays ARE populated (6 ICD-10 + 6 SNOMED + 11 LOINC). Prior `notes` saying "Regimen axis intentionally empty" and "Terminology arrays empty" were stale comments left over from a pre-2026-04 snapshot and have been removed. Verified 2026-05-12 (B.5 lane): SNOMED/LOINC mislabel pattern flagged in Wave 3 residual report (codes 88327002 / 27392003 / 5765003 appearing inside loinc_codes[]) is NOT present in this file. SNOMED codes are correctly in terminology.snomed[] (78048006 Candida septicemia, 91861009 invasive candidiasis, 7919003 candidemia, 11052003 Candida endocarditis, 186346007 peritonitis, 416886005 pyelonephritis). LOINC codes are correctly LOINC. Per post-wave4-remaining-gaps.md §"Carry-forward content fixes" the issue is marked resolved. Drug-interaction safety formalised 2026-05-12: prior narrative-only DDI guidance for fluconazole+warfarin / +tacrolimus / +statins and voriconazole+tacrolimus is now in the contraindication_rules[] array as 4 structured safety:* identifiers, so the safety engine surfaces them at regimen-build time. PMIDs: IDSA 2016 candidiasis (26679628) + Mermel CRBSI 2009 (19489710). Refresh when ESCMID 2024-2025 / IDSA 2025 candida or C. auris update publishes. PRODUCTION blockers: no protocol.candidemia_bundle registered in protocol registry; no dedicated test file for candidemia regimen builder; RxCUI revalidation pending for echinocandins (rezafungin RxCUI not yet captured — newer IDSA Q4 alternative).

Entry points (4)

  • lab_abnormality
    Blood culture growing yeast (IDSA 2024)
    blood_culture_yeast
  • lab_abnormality
    Beta-D-glucan elevated in high-risk patient (IDSA 2024)
    beta_d_glucan_positive
  • symptom
    Persistent fever on broad-spectrum antibiotics (IDSA 2024)
    persistent_fever_on_broad_abx
  • problem_list
    Central line in patient with risk factors (TPN, abx, ICU) (IDSA 2024)
    central_venous_catheter_in_situ

Required inputs (12)

  • temperaturerequired
    vital • used at ENTRY
    Persistent fever despite broad antibiotics is a sentinel sign (IDSA 2024)
  • sbprequired
    vital • used at RED_FLAGS
    Septic shock from candidemia mortality 40-60% — drives ICU disposition (IDSA 2024)
  • central_venous_catheterrequired
    history • used at CONTEXT
    Removal of non-tunneled CVC is a Class A IDSA recommendation
  • recent_broad_spectrum_abxrequired
    history • used at CONTEXT
    Major risk factor; informs species probability (IDSA 2024)
  • tpn
    history • used at CONTEXT
    Lipid emulsions support C. parapsilosis; high-risk population (IDSA 2024)
  • neutropeniarequired
    history • used at CONTEXT
    Neutropenic phenotype favors echinocandin + lipid amphotericin and aggressive imaging for hepatosplenic candidiasis (IDSA 2024)
  • blood_culturerequired
    lab • used at INITIAL_WORKUP
    Diagnostic anchor; also drives line-removal timing (IDSA 2024)
  • beta_d_glucan
    lab • used at INITIAL_WORKUP
    Adjunct when culture negative; supports invasive candidiasis without candidemia (IDSA 2024)
  • creatininerequired
    lab • used at TREATMENT
    Echinocandin renal-safe; fluconazole / lipid AmB renal dosing/toxicity (IDSA 2024)
  • lft
    lab • used at MONITORING
    Azole hepatotoxicity monitoring (IDSA 2024)
  • echocardiogram_tee
    imaging • used at BRANCHING_WORKUP
    TEE if persistent candidemia >5d, valvular disease, prosthetic valve, or embolic phenomena (IDSA 2024)
  • dilated_fundoscopyrequired
    imaging • used at BRANCHING_WORKUP
    Ophtho exam within 1 week of diagnosis (IDSA 2016) and repeat at 2 weeks

12-phase flow (12)

  1. 1FRAME
    Confirm bloodstream / deep-tissue Candida disease scope (IDSA 2024)
    advance: scope confirmed
  2. 2ENTRY
    Yeast on blood culture, persistent fever on broad abx, or compatible deep-organ findings (IDSA 2024)
    inputs: temperature
    advance: entry trigger validated
  3. 3CONTEXT
    Capture CVC, prior abx, neutropenia, surgery, TPN, prior azole exposure (resistance risk) (IDSA 2024)
    inputs: central_venous_catheter, recent_broad_spectrum_abx, neutropenia
    advance: risk profile documented
  4. 4RED_FLAGS
    Septic shock, neutropenic fever, prosthetic valve, suspected endocarditis → ICU + immediate echinocandin (IDSA 2024)
    inputs: sbp
    actions: calc.qsofa
    advance: shock or endocarditis flag addressed
  5. 5INITIAL_WORKUP
    Daily blood cultures until clearance, species + susceptibilities, beta-D-glucan if culture-negative, baseline LFT/renal (IDSA 2024)
    inputs: blood_culture, creatinine
    advance: cultures + species pending; empiric started
  6. 6BRANCHING_WORKUP
    Ophtho fundoscopy ≤1 week + repeat 2 weeks; TEE if persistent / prosthetic / embolic; abdominal imaging if neutropenic recovery → hepatosplenic candidiasis (IDSA 2024)
    inputs: dilated_fundoscopy
    advance: end-organ workup complete
  7. 7DIFFERENTIAL
    Distinguish C. albicans / glabrata (echinocandin) / parapsilosis (fluconazole-favoured) / krusei (azole-resistant) / auris (multidrug-resistant — isolation) (IDSA 2024)
    advance: species + susceptibility known
  8. 8RISK_STRATIFICATION
    Persistent candidemia >5d, immunocompromise, valve disease drive duration + IDSA escalation
    advance: duration + endocarditis ruled in/out
  9. 9TREATMENT
    Echinocandin first-line (caspofungin / micafungin / anidulafungin) IDSA 2016 strong; remove CVC if non-tunneled; transition to fluconazole when stable + susceptible; lipid AmB for refractory or CNS disease; min 14 days from first negative culture; longer for endocarditis / endophthalmitis / hepatosplenic
    inputs: creatinine
    advance: echinocandin started + CVC managed within 24-48h
  10. 10DISPOSITION
    ICU if shock or neutropenic; otherwise inpatient with ID consult (IDSA 2024)
    inputs: sbp
    advance: level of care set
  11. 11MONITORING
    Daily blood cultures until 2 consecutive negatives; LFT q3-7d on azole; renal q3-7d on lipid AmB; ophtho repeat 2 weeks (IDSA 2024)
    inputs: lft, creatinine
    actions: panel.lft, panel.renal
    advance: cultures cleared, end-organ followup booked
  12. 12FOLLOWUP
    ID outpatient follow-up; species-stewardship feedback; antifungal taper plan (IDSA 2024)
    advance: ID f/u scheduled